m 


REPORT 


or   THE 


ROYAL   ACADEMY   OF  MEDICINE, 


TO    THE 


MINISTER  OF  THE  INTERIOR, 


UPON    THE 


CHOLERA-MORBUS. 


PUBLISHED  BY  ORDER  OF  THE 


FRENCH   GOVERNMENT. 


TRANSLATED  FR03I  THE  FRENCH  BY 

JOHN  W.   STERLING,  M.  D. 

MEMBER.  OF   THE    COLLEGE    OF   SURGEONS,    LONDON,  &   FELLOW   OF 
THE    UNIVERSITY    OF    THE    STATE    OF    NEW-YORK. 


MEW-YORK: 
SAMUEL  WOOD  &  SONS,  261  PEARL-STREET. 

1832. 


PRINTED  AT  THE   OFFICE 

of  the 

MXZDXCO-CHXBURGXCAXi   REVIEW. 

No.  261  Pearl-street. 


^N^. 


A 

B 


TO 
THOMAS    COCK,    31.  D. 

VICE-PRESIDENT    OF  THE 

UNIVERSITY  OF  THE  COLLEGE  OF  PHYSICLVNS  AND  SURGEONS 

OF  THE  STATE  OF  NEW- YORK, 

ONE  OF  THE  PHYSICIANS  OF  THE  NEW- YORK 

HOSPITAL,    &c. 

THLS  TRANSLATION  IS  INSCRIBED 

BY  HIS  VERY  MUCH  OBLIGED  AND  OBEDIENT  SERVANT, 

JOHN    W.    STERLING. 


TRANSLATOR'S  PREFACE. 


The  following  translation  has  been  undertaken  with 


"O 


the  view  of  introducing  into  general  circulation  the 
opinions  entertained  by  some  of  the  most  enlightened 
physicians  of  France,  and  of  the  numerous  authors 
whose  works  they  have  carefully  investigated,  relatively 
to  the  history,  nature  and  most  approved  treatment  of 
the  Spasmodic  Cholera. 

The  great  ravages  already  Committed  by  this  dis- 
ease, and  the  rapidity  with  which  it  has  extended  to 
different  and  numerous  kingdoms  of  the  old  world, 
have  excited  alarm  and  dpprehension  in  the  breast  of 
almost  every  individual  of  this  country.  Indeed,  reign- 
ing as  an  epidemic,  we  h<!ve  great  reason  to  apprehend 
its  awful  visitation,  and  rh  order  that  it  may  not  come 
upon  us  unawares,  it  is  incumbent,  on  physicians 
especially,  to  apply  to  every  source  whence  they  may 
ascertain  the  best  means  of  preventing  its  invasion, 
restricting  its  limits,  and  subduing  its  deadly  effects 
in  those  who  may  become  the  subjects  of  it. 

Previous  to  the  reception  of  the  Report  of  the  French 
Academy  in  our  city,  the  excellent  Discourse  by  Prof. 
J.  M.  Smith,  on  the  Epidemic  Cholera,  had  been  for 


8 

some  time  before  the  public.  In  collating  this  dis- 
course with  the  report  of  the  Academy,  we  were  struck 
with  the  similarity  of  their  conclusions  ;  yet  it  could  be 
no  longer  a  matter  of  surprise  when  it  was  fully  ascer- 
tained that  the  method  adopted  by  both  parties,  in  order 
to  arrive  at  these  conclusions,  had  been  exactly  similar, 
viz.,  the  deep  and  accurate  investigation  of  every  im- 
portant accessible  document  relating  to  the  subject  of 
Cholera,  allowing  their  deductions  to  flow,  as  it  were, 
naturally,  from  the  various  sources  whence  they  had 
originated. 

Yet,  notwithstanding  their  general  resemblance, 
there  are  one  or  more  points  on  which  a  difference  of 
opinion  exists :  we  are  disposed  to  believe,  however, 
that  these  discrepancies  are  more  apparent  than  real, 
and  that  there  would  be  no  great  difficulty  in  recon- 
ciling them.  We  allude  to  the  contagious  character  of 
the  Cholera  ;  the  authors  of  the  subjoined  Report,  as 
will  be  seen  on  examining  it,  being  of  opinion  that  this 
disease  has,  under  certain  conditions,  been  communi- 
cated by  personal  contact. 

That  persons  in  constant  and  untiring  attendance 
on  the  couch  of  an  individual  labouring  under  the 
Cholera,  are  more  liable  to  be  attacked  in  their  turn 
than  those  who  keep  aloof  from  the  presence  of  the 
disease,  we  can  readily  conceive,  and  the  reason 
seems  obvious  :  the  sick  person  is  located  in  an  im- 
pure atmosphere,  probably  in  the  very  centre  of  the 
epidemic  influence,  he  is  surrounded  by  friends,  all 


9 

eager  to  attend  to  his  every  want,  who  render  the  at- 
mosphere still  more  impure  by  the  exhalations  which  pro- 
ceed from  their  lungs  and  bodies,  probably  equally  pre- 
judicial to  health  with  the  emanations  arising  from  the 
diseased  body  :  the  minds  of  these  friends  are  greatly 
distressed,  both  in  consequence  of  beholding  the  ago- 
nies of  the  sufferer  and  anticipating  the  desolation  which 
will  attend  on  his  taking  off;  the  fatigue  also,  the  want 
of  sufficient  and  regular  alimentation ;  all  these  circum- 
stances constitute  some  of  the  most  powerful  predis- 
posing causes  of  the  disease.  Can  we  wonder  then 
that  persons  exposed  to  the  influence  of  these  causes 
should  be  more  susceptible  of  an  attack  than  those  who 
are  not  subject  to  their  influence  ?  And  can  we  be 
surprized  that  persons,  unacquainted  with  the  laws 
which  govern  epidemics,  seeing  attacks  frequently  and 
rapidly  treading  upon  such  exposures,  should  derive 
them  from  direct  contagion  ?  Is  it  not  more  natural 
to  attribute  the  causes  of  violent  effects  to  visible  and 
palpable  objects  rather  than  derive  them  from  occult 
invisible  agents  which  have  never  been  demonstrated  to 
exist  otherwise  than  from  analogy  1  It  ought  not  then 
to  be  a  matter  of  surprise,  to  medical  men,  even  if 
every  instance  of  invasion  of  this  disease  were  attrib- 
uted, by  those  who  cannot  comprehend  epidemial  influ- 
ence, to  individual  contagion. 

We  were  almost  on  the  point  of  uttering  the 
wish  that  the  disease  were  contagious,  rather  pre- 
ferring its  invasion  in  that  way  than  in  an  epidemic 


10 

form  ;  for,  in  the  one  case,  our  quarantine  laws  would 
greatly  tend  to  arrest  its  progress,  or  else  we  would  be 
able  to  flee  from  its  direful  influence  ;  but,  where 
it  pervades  the  atmosphere,  travelling  on  the  wings 
of  the  wind,  and  may  approach  us  in  every  gale  that 
blows  across  the  Atlantic,  or  descend  upon  us  with 
dreadful  rapidity  from  the  northern  extremity  of  Asia, 
we  have  great  reason  for  the  preference  ;  all  human 
regulations  being  of  no  avail  in  stemming  the  current 
of  the  elements. 

Sanatory  measures,  however,  should  be  resorted 
to,  especially  such  as  have  proved  beneficial  either 
in  lessening  the  pre-disposition  to  the  disease,  or 
diminishing  its  violence  among  individuals  or  com- 
munities exposed  to  its  invasion,  and  which  are  fully 
detailed  in  the  report  of  the^Academy. 

There  is  one  thought  which  has  been  elicited  by  a 
remark  contained  in  the  following  pages,  and  which 
we  consider  of  no  small  degree  of  importance :  it  is 
this: —  , 

If  the  Cholera  should  invade  our  land,  let  there  be 
a  mutual  understanding  among  physicians  that  they 
will  reciprocally  assist  one  another  in  the  services  they 
may  render  to  persons  attacked  with  this  malady  ;  for 
this  is  a  disease  so  terrible  in  its  aspect,  as  to  appal  even 
the  stoutest  heart ;  so  dreadfully  rapid  is  its  progress, 
and  so  soon  does  it  cover  its  victim  with  the  semblance 
of  death,  that  the  physician  might  possibly  consider  it 
needless,  in  such  a  case,  to  attempt  to  snatch  the  vie- 


11 

tim  from  the  reality,  even  though  the  effort  might  be 
most  availing.  Therefore  is  it  necessary  that  physi- 
cians should  strengthen  the  hands  of  one  another,  and 
by  their  united  efforts  persevere  so  long  as  life  can  pos- 
sibly be  supposed  to  exist ;  for  it  is  thus  alone  that 
others  have  prevailed  over  this  cruel,  this  merciless 
destroyer. 

Finally,  let  the  physician,  who  should  be  called  on 
to  succour  an  individual  attacked  with  the  Cholera,  go 
instantly ;  let  him  not  hesitate,  through  a  fastidious  ad- 
herence to  the  strict  rules  of  medical  ethics,  and  the 
fear  of  infringing  upon  the  rights  of  a  fellow-practi- 
lioner,  to  go  on  the  instant ;  for,  in  this  disease,  life 
hangs  on  instants,  and  death  waits  not  for  ceremony. 


FIRST  FART. 


REPORT 


ON    THE 


CHOLERA- MORBUS, 


READ   BEFORE   THE 


ROYAL  ACADEMY  OF  MEDICINE, 


IN 


GENERAL    SESSION, 

ON  THE  26TH  &  30TH  JULY,   1831. 


REPORT 


ON    THE 


CHOLERA-MORBUS, 


The  Royal  Academy  of  Medicine  has  received  from 
the  Minister,  Secretary  of  State  for  the  Department 
of  the  Interior,  the  following  letter,  addressed  to  its 
President,  dated  March  4th,  1831,  which  we  will  now 
read  : — 

"  Monsieur  le  Baron, 
"  The  Board  of  Health*  of  Marseilles  has  written  me,  that, 
in  consequence  of  the  great  number  of  vessels  which  arrive  at 
that  port  from  the  Baltic  and  the  Black  Sea,  it  has  great  reason 
to  apprehend  that  the  Cholera-Morbus  will  make  its  appearance 
in  the  health  establishments  there  situated  ;  that,  consequently, 
it  cannot  acquire  too  much  information  respecting  this  disease. 
It,  therefore,  beseeches  me  to  consult,  on  the  nature  of  the 
Cholera-Morbus  as  well  as  upon  its  most  appropriate  preventive 
and  curative  means,  the  Societies  of  Medicine  and  other  learned 

*  Intendance  Sanitaire. 


2 

bodies  of  the  capital,  in  order  that  such  means  may  be  had  re- 
course to  in  case  their  apprehensions  should  be  realized. 

"  The  Royal  Academy  of  Medicine  being  constituted  the  legal 
counsel  of  the  Government  in  every  thing  that  concerns  the  public 
health,  it  is  to  it  alone  that  I  consider  it  my  duty  to  address  my- 
self. I  request  you,  M.  le  Baron,  to  invite  this  Society  to  under- 
take, with  the  least  possible  delay,  the  compilation  of  such  in- 
structions as  may  serve  to  direct  the  Boards  of  Health  of  the 
Kingdom  in  the  application  of  those  preservative  and  curative 
means  which  they  should  employ  against  the  Cholera,  and  to 
enable  them  to  recognise,  in  the  surest  possible  manner,  the 
symptoms  of  this  cruel  malady. 

"  I  anticipate  from  the  zeal  for  the  public  welfare,  of  which  the 
Academy  has  already  given  so  many  proofs,  that  it  will  eagerly 
comply  with  this  request,  by  furnishing  me  with  the  work  in 
question. 

(Signed) 

MONTALIVET, 
Peer  of  France,  Minister  of   the 
Interior,  Secretary  of  State." 

In  consequence  of  this  letter,  the  Academy  appointed 
a  Committee,  composed  of  MM.  Keraudren,  Chomel, 
Coutanceau,  Boisseau,  Desportes,  Marc,  Dupuytren, 
Pelletier,  Louis,  Desgenettes,  Emery  and  Double,  for 
the  purpose  of  preparing  a  Report  upon  this  subject. 
It  is  the  work  of  this  Committee  that  I  am  deputed  to 
submit  to  the  Academy. 

This  is  a  grave  subject,  Gentlemen ;  it  concerns 
almost  every  nation,  whom  it  disturbs,  whom  it  threat- 
ens, or  whom  it  attacks  in  their  dearest  interests.  The 
matter  is  arduous,  immense  ;  it  is  sufficient  to  tell  you 


that  we  will  be  minute,  very  minute.  But  in  consider- 
ing a  question  in  which  every  thing  is  new  to  us,  we 
must  present  to  your  view  a  summary  of  all  the  facts, 
of  all  the  doctrines  contained  in  the  numerous  docu- 
ments in  existence.  , 

The  symptomatology  of  Cholera,  its  necroscopic 
characters,  the  seat  and  nature  of  the  disease,  the 
chances  of  safety  or  of  destruction,  its  treatment,  the 
geographical  march  of  the  disease  under  the  influence  of 
causes  which  favour  the  extension  of  it,  the  prophylac- 
tic means  and  sanative  measures  employed,  we  have 
investigated  ;  notwithstanding  each  of  these  divisions 
has  been  successively  studied,  first  in  Asia,  and  after- 
wards in  Europe. 

But  then,  when  we  shall  have  completed  the  reading 
and  the  discussion,  the  Academy  will  have  shared  in  all 
the  labours  of  the  Committee,  or  rather  these  labours 
will  have  been  executed  entirely  under  its  supervision. 
You  will,  we  are  persuaded,  have  no  cause  to  regret  so 
much  pains  bestowed,  especially  if  we  have  had  the 
happiness  of  rendering  them  profitable. 

When  the  Academy  shall  have  adopted  the  Report 
and  its  deductions,  it  will  remain  to  digest  a  circum- 
stantial instruction,  addressed  to  the  administrative 
authorities,  to  the  members  of  the  profession,  and  to 
the  individuals  of  the  countries  threatened  or  attacked, 
in  order  to  determine  by  elaborate  and  luminous  details, 
what  each  should  perform  within  the  limits  of  its  duties 
and  jurisdiction. 


Another  work  will  also  remain  to  be  performed  ;  it 
is  a  report  upon  the  documents  transmitted  to  the 
Academy,  in  order  to  establish  their  respective  value, 
and  determine  the  services  which  each  author  of  these 
documents,  in  particular,  shall  have  rendered  to  the 
Academy  and  to  the  Science.  It  is  upon  the  accuracy 
of  these  documents,  it  is  upon  their  completeness  that 
the  success  of  the  Report  depends. 

For  we  have  only  been  able  to  work  from  documents ; 
and  documents,  whatever  may  be  their  accuracy,  never 
come  up  to  all  the  ideas,  all  the  expectations,  and  all 
the  exigencies  of  the  mind  which  elaborates  them. 

Many  deficiencies  will  fortunately  be  filled  up  by  the 
young  men,  enlightened  physicians,  brave  savans,  whom 
the  Academy  has  deputed  at  Warsaw  and  St.  Peters- 
burg. 

Furthermore,  if  the  investigation  of  such  a  subject, 
at  a  distance  from  epidemic  danger  and  tumults,  has  its 
inconveniencies,  it  is  on  the  other  hand  attended  with 
its  advantages.  In  this  respect,  it  is  with  great  epidem- 
ics, in  the  physical  world,  as  with  revolutions  in 
the  political :  in  the  midst  of  the  violent  jars  and 
sudden  revolutions  which,  at  intervals,  agitate  nations, 
contemporaries,  during  the  strife  of  opinions  and  the 
shock  of  parties,  may  indeed  collect  materials  or  even 
draw  up  particular  memoirs  ;  but  the  history  of  these 
strange,  these  dreadful  epochs,  can  only  be  written  at 
a  distance  from  the  events  which  have  accomplished 
them. 


REPORT. 


Committee  : — MM.    Keraudren,    President  ;  Marc, 
Chomel,    Coutanceau,   Boisseau,    Desportes, 

DUPUYTREN,    PELLETIER,     LoUIS,    DeSGENETTES, 

&  Emery  ;   Double,  Reporter. 


The  Cholera-Morbus — as  if  this  malady  were 
the  only,  the  exclusive  malady,  and  that  all  others 
scarcely  deserved  the  name — the  Cholera-Morbus 
is  a  disease  the  knowledge  of  which  ascends  to  the 
remotest  times  of  medical  observation.  Alreadv 
very  clearly  pointed  out  by  Hippocrates,  who  sub- 
dued it  by  the  assistance  of  warm  fomentations,  it 
has  been  admirably  described  by  Araetius  of  Cap- 
padocia.  The  perspicuous,  concise,  accurate  and 
complete  symptomatology,  which  this  author,  who 
wrote  at  the  beginning  of  the  fifth  century,  has  re- 
corded, compared  even  with  recent  descriptions,  or 
those  of  the  present  day,  scarcely  leaves  anything 

2* 


to  be  desired  by  the  most  fastidious  individual ;  and 
authors  have  scarcely  done  more  than  copy  what 
Araetius  long  since  wrote  on  the  subject. 

This  disease,  sui  generis,  the  characters  of  which 
are  distinct  and  constant,  has  frequently  presented 
itself  to  the  notice  of  observers  of  every  country. 
It  has  often  been  observed  appearing  accidentally 
in  a  single  individual  or  in  several  isolated  persons, 
developed  by  the  action  of  particular,  idiosyncratic 
predisposing  causes,  and  then  confined  to  these  nar- 
row limits.  In  this  state  it  is  called  sporadic  ;  there 
is  no  physician,  of  ever  so  little  experience,  who 
cannot  cite  examples  of  it. 

Neither  is  it  rare  to  see  the  Cholera  reign  occa- 
sionally under  the  influence  of  a  determinate  con- 
stitution of  the  atmosphere,  and  in  the  form  of  a 
popular  disease,  or  minor  epidemic,  as  stated  by 
Fouquet.  This  mode,  more  justly  named  catastatic, 
in  order  to  express  that  it  depends  especially  upon 
the  regular  but  exaggerated  constitution  of  the 
seasons,  has  often  been  the  mode  pursued  by  the 
Cholera.  Thus  was  it  recorded  by  Hippocrates  in 
the  seventh  book  on  Epidemics:  thus  was  it  ob- 
served by  Sydenham,  in  London,  in  1669  and  1676; 
by  Huxham,  in  1741  ;  thus  was  it  noticed  in  Paris 
at  different  epochs,  and  more  especially  during  the 
summer  of  1730,  and  in  July,  1780,  at  which  times 
it  was  already  remarked  that  the  disease  was  more 


fatal  to  men  than  to  women.  Thus  was  it  de- 
scribed, in  upper  India,  by  Lebegue,  of  Presle,  in 
1762;  Paisley,  in  1774;  by  Sonnerat,  from  1774  to 
1781  ;  by  Curtis  and  Girdleston,  in  1781  and  1782  ; 
Thomson,  in  1787 :  thus  did  it  appear  to  Doctor 
Noel,  (then  surgeon-in-chief  of  the  expedition,) 
among  the  French  troops  who,  during  the  last  cen- 
tury, were  sent  to  contest  with  England  the  do- 
minion of  the  peninsula  of  India.  Disembarked 
upon  the  coast  of  Coromandel,  the  French  army 
suffered  greatly  from  this  epidemic,  which  was 
successfully  treated  bv  means  of  divided  doses  of 
Volatile  Alkali  given  internally,  repeated  every  two 
hours,  and  administered  in  an  infusion  of  sweeten- 
ed balm  tea. 

But  under  all  these  circumstances,  the  cholera 
has  never  extended  beyond  the  influence  of  the 
medical  constitution  with  which  it  was  found  con- 
nected. 

The  annals  of  science  also  present  the  Cholera 
in  certain  localities,  in  particular  countries,  this  is 
the  endemic  Cholera.  Bontius,  who  wrote  in  1669, 
had  already  described  it  under  this  form  in  India. 
Dillon  and  Lind  thus  observed  it  in  the  same 
countries ;  and  since  that  epoch,  the  useful  labours 
and  the  learned  memoirs  of  the  Physico  Medical 
Society  of  Calcutta,  have  derived  similar  results 
from  clinical  observations.     This  endemic  Cholera 


8 

does  not  extend  beyond  the  limits  assigned  to  it  by 
the  local  causes,  of  which  it  is  the  effect. 

Lastly,  the  Cholera  exists  in  the  symptomatic 
form,  connected  in  different  cases  with  severe,  acute 
diseases.  In  southern  climates  we  find  it  connect- 
ed with  high  grades  of  bilious  fever,  and  with  intense 
typhoid  fevers.  Such  examples  are  not  rare.  M. 
Bally  has  seen  the  Cholera  decidedly  complicated 
with  a  case  of  yellow  fever  ;  and  our  colleague 
Dr.  Jackson  had  previously  described  a  Choleric 
yellow  fever,  of  which  he  has  given  the  symptoma- 
tology, the  anatomical  characters,  and  the  treat- 
ment. Torti,  and  other  observers,  since  his  time, 
have  treated  the  predominant  and  violent  symp- 
toms of  Cholera  in  irregular  (ataxic)  remittent 
fevers. 

It  is  consequently  well  established  that  the  Chol- 
era has  been,  from  time  immemorial,  observed  in 
the  sporadic  state,  in  the  catastatic  state,  in  the  en- 
demic state,  in  the  symptomatic  state,  and  that,  in 
these  different  conditions,  it  is  never  propagated 
beyond  the  circumstances  which  attended  upon 
its  origin. 

Let  us  deliberate  upon  this  first  order  of  facts, 
and  again  let  us  recapitulate,  and  with  design,  those 
general  results  which  have  been  drawn  from  in- 
contestable observation  and  irresistible  evidence. 
Clinical  instructions  show  us  the  manifestations  of 


the  isolated,  sporadic  Cholera,  in  individuals  ex- 
posed to  the  causes  capable  of  producing  it.  Every 
physician  has  seen  examples  of  it.  provided  his 
practice  has  placed  him  in  the  midst  of  circum- 
stances more  or  less  capable  of  giving  rise  to  simi- 
lar symptoms. 

We  can  quite  as  easily  conceive  the  facts  of 
Cholera  existing  in  a  certain  number  of  cases  at 
determinate  epochs  of  the  year,  through  the  influ- 
ence of  constitutions  of  the  seasons  and  of  con- 
fined medical  constitutions.  There  are  few  coun- 
tries in  which  clinical  observation  has  not  de- 
tected the  catastatic  form  of  Cholera. 

We  can  also  readily  conceive  that,  under  the 
influence  of  certain  climates,  from  the  effect  of 
particular  drinks  and  aliments,  and  in  consequence 
of  determinate  localities,  the  Cholera  exists  in  the 
endemic  state : — the  East  Indies,  since  they  have 
been  medically  investigated,  are  an  incontestable 
proof  of  it. 

Finally,  facts  have  also  presented  themselves, 
which  compel  us  to  admit  that  the  Cholera,  with  all 
the  characters  which  are  peculiar  to  it,  manifests 
itself  symptomatically  in  some  cases  of  malignant 
fever,  and  that  it  does  not  extend  beyond  these  in- 
dividualities, with  which  it  is  closely  connected. 

There  is  then  no  absolute,  natural,  necessary, 
inevitable  property  in  Cholera,  of  extending  from 
one  individual  to  another.   The  Cholera  is  not  then, 


10 

by  its  nature,  essentially,  primitively  transmissible, 
since  it  has  very  manifestly  been  observed  in  all 
ages,  and  by  all  physicians,  in  the  sporadic  slate, 
the  catastatic  state,  the  endemic  state,  and  the  symp- 
tomatic state,  without  ever  having  passed  beyond 
the  limits  assigned  to  the  particular  causes  which 
have  thus  been  shown  to  originate  it. 

Should  the  other  scholastic  divisions  of  Cholera 
detain  us  even  an  instant  ?  Eminently  practical 
geniuses,  Hoffman  and  Frank  especially,  have  al- 
ready done  justice  to  them.  As  for  us,  we  write 
under  circumstances  too  serious,  to  lay  any  stress 
upon  these  speculative  subtleties. 

But  the  Cholera  reigning  in  great  epidemics,  in 
spreading  and  devastating  epidemics,  by  the  effect 
of  circumstances  which  cannot  be  rigorously  ap- 
preciated or  understood,  from  the  action  of  occult 
causes  which  can  neither  be  controlled  nor  foreseen, 
independently  of  special  conditions  and  physical 
individualities,  unconnected  with  atmospherical  vi- 
cissitudes and  the  modification  of  seasons  which 
give  rise  to  it,  exclusively  of  the  local  peculiarities 
and  hygienic  influences  which  produce  it,  remote 
from  acute  diseases  and  those  febrile  conditions 
with  which  it  is  connected ;  the  Cholera  thus  pro- 
duced has  not  hitherto  been  presented  to  medical 
investigation  ;  and  it  is  precisely  in  this  state  that 
we  are  called  upon  this  day  to  devote  to  it  our 
most  diligent  attention. 


PART  FIRST. 


SYMPTOMATOLOGY. 

The  Cholera  in  its  violent  epidemic  form  has, 
for  nearly  fifteen  years,  exercised  its  fatal  ravages 
upon  the  scarcely  explored  soil  of  upper  India  ;  and 
for  about  three  years  has  sought  to  place  its  foot 
upon  our  ancient  Europe. 

Two  different,  we  might  even  say  opposite, 
theatres,  are  thus  almost  simultaneously  opened 
to  this  fatal  epidemic :  the  one  is  the  burning  soil 
of  the  principal  districts  of  the  peninsula  of  India; 
and  the  other,  several  governments  of  the  Russian 
Empire,  and  several  parts  of  northern  Europe.  Let 
us  examine  the  disease  successively  upon  both  of 
these  theatres. 

Upon  the  continent  of  Asia,  the  Cholera  has  pre- 
sented the  following  characters  : 

General  uneasiness,  accompanied  by  a  painful 
sensation  of  heat  in  the  epigastrium  ;  weariness  of 
the  extremities  ;  greater  or  less  debility ;  oppres- 
sion ;  the  physiognomy  of  the  patient,  which  at 
first  expressed  only  uneasiness,  changes  more  or 
less  rapidly,  according  to  circumstances,  to  the  ex- 


12 

pression  of  great  anxiety  ;  at  this  moment  the  pulse 
is  quick,  but  hard  and  contracted. 

This  is  the  period  of  invasion  of  the  disease,  a 
period  observed  by  many  practitioners,  Annesley, 
Colledge,  &c.  ;  disputed  on  the  other  hand  by 
Scott  and  some  other  authors. 

Now,  let  us  say  in  anticipation,  that  Dr.  Annesley 
attaches  to  this  period  so  much  the  more  import- 
ance, inasmuch  as,  according  to  him,  it  is  chiefly  by 
acting  precisely  at  this  instant  that  the  assistance  of 
art  fortunately  succeeds  in  arresting  the  disease,  by 
stifling  it  in  its  work  of  formation,  or  at  least  by 
preparing  it  for  a  successful  termination. 

The  primary  symptoms  are  sometimes  accompa- 
nied, or  at  least  immediately  followed,  by  a  very 
severe  pain  at  the  pit  of  the  stomach,  which  soon 
invades  the  entire  digestive  tube  :  this  is,  of  all 
symptoms,  the  most  durable  and  the  most  constant, 
and  is  one  of  the  characteristic  signs  of  the  disease. 

Next,  repeated  vomitings  supervene,  the  stools 
become  frequent,  attended  with  a  painful  sensation 
of  prostration,  exhaustion,  and  as  it  were  of  general 
vacuity.  Irregular  spasmodic  contractions,  violent 
cramps,  seize  upon  the  superior  and  inferior  extrem- 
ities, which,  together  with  the  fatigue  produced 
by  the  repeated  vomitings  and  frequent  dejections, 
cruelly  torture  the  patient. 


13 

The  evacuations,  exclusively  composed  at  first  of 
the  substances  contained  in  the  stomach  and  intes- 
tines at  the  invasion  of  the  disease,  soon  assume 
a  particular  pathognomonic  character ;  they  con- 
sist of  a  whitish,  serous,  aqueous  fluid,  somewhat 
analogous  to  a  decoction  of  rice  mixed  with  albu- 
minous flakes,  or  to  the  liquid  evacuated  by  the 
operation  of  paracentesis  :  sometimes  these  sub- 
stances are  still  thicker,  muddy,  and  interspersed 
with  diverse  grey  and  greenish  colours,  but  rarely 
bloody.  Occasionally  the  alvine  dejections  are  for- 
cibly expelled  from  the  intestines,  and  as  it  were  by 
the  jet  of  a  syringe,  even  in  an  advanced  period  of 
the  disease. 

There  is  an  absence  of  febrile  re-action ;  the  pulse 
is  small,  vacillating  irregular,  nervous  ;  it  rather 
vibrates  than  beats.  This  absence  of  all  re-action, 
even  though  it  may  be  only  a  negative  symptom,  is 
one  of  the  most  decided  characteristics  of  this  dis- 
ease. Except  in  very  rare  cases  of  accidental  com- 
plication, the  equally  uncommon  cases  of  typhoid 
terminations  or  mutations,  or  those  in  which  the 
tendency  to  cure  manifests  itself  and  persists  a 
greater  or  less  length  of  time,  never,  in  this  period, 
has  any  severe  symptom  of  the  choleric  epidemic 
assumed  the  febrile  form  unless  the  disease  ter- 
minated favourably. 


14 

The  flow  of  urine  is  entirely  suspended  ;  the  se- 
cretion of  it  does  not  go  on  at  all ;  necroscopic  ob- 
servations unite  with  the  symptomatology  to  prove 
the  complete  vacuity  of  the  bladder. 

The  spasms  rapidly  assume  a  greater  degree  of 
intensity ;  they  successively,  and  in  a  very  short 
period,  run  through  the  inferior  and  supeiior 
extremities,  the  abdominal  muscles,  and,  in  the 
last  place,  the  thoracic  and  diaphragmatic  mus- 
cles ;  but  they  rarely  extend  to  the  muscles  of  the 
back,  face,  or  loins.  These  spasms  are  rather  of 
the  clonic  than  of  the  tonic  character. 

Then  also  supervene  deafness,  giddiness,  tinkling 
in  the  ears,  and  coldness  of  the  whole  body.  A 
great  anxiety  at  the  precordial  region  manifests  it- 
self; it  is  connected  with  an  extreme  difficulty  of 
breathing,  and  excessive  debility  of  the  whole  sys- 
tem. The  air  expired  by  the  patient  is  destitute  of 
all  warmth.  The  skin  is  covered  with  a  cold  sweat ; 
and  this  cold,  this  humidity,  sometimes  augments  to 
such  a  degree,  that  the  dermis  is  corrugated  and 
folded  as  if  the  skin  had  been  macerated  for  a  long 
time  in  warm  water,  or  covered  by  an  emollient 
cataplasm. 

In  many  cases,  the  skin,  throughout  its  whole  ex- 
tent, or  in  certain  points,  assumes  a  leaden,  bluish, 
and  livid  tint. 


15 

The  sunken  countenance  ;  the  deep,  hollow  eye, 
surrounded  by  a  livid  circle,  and  the  pinched  fea- 
tures;  all  give  to  the  patient  a  ghastly  appear- 
ance. According  to  the  saying  of  almost  all  ob- 
servers, the  face  of  cholerics,  differing  but  little  from 
the  hippocratic  face,  is  so  highly  characteristic,  that 
this  sign  would  of  itself  suffice  for  the  diagnosis 
of  the  disease.  The  face  is  triangular,  says  Dr. 
Blahodatoff,  who  observed  the  disease  in  the  district 
of  Samarski,  government  of  Orenburgh. 

The  pulse  is  contracted,  small  to  excess,  it  is  diffi- 
cult to  seize  it,  and  frequently  the  pulsations  at  the 
wrist  are  wanting ;  they  are  even  scarcely  percepti- 
ble at  the  heart.  At  this  period,  the  blood,  which 
a  little  time  previous  was  oily,  thick,  black,  and 
escaped  but  with  difficulty  from  the  vein,  can  no 
longer  escape  from  it,  or  at  least  is  expressed  from 
it  with  difficulty. 

The  patient  experiences  an  insatiable  thirst,  he 
swallows  with  avidity  cool  liquids  ;  notwithstanding 
the  tongue  and  mouth  are  pale,  white,  moist  and 
cold.  The  voice  is  feeble  and  sepulchral.  There 
are  vague  jactitations  of  which  the  patient  is  scarcely 
conscious  ;  and  though  he  may  retain  the  integrity 
of  his  intellectual  faculties,  all  the  vital  actions  are  in 
such  a  state  of  exhaustion,  that  he  lies  incomplete  un- 
consciousness of  his  condition,  and  obstinately  wishes 
to  remain  at  rest,  totally  indifferent  to  what  is  doing 


16 

for  his  relief,  and  to  every  thing  that  is  passing 
around  him.  Death  generally  happens  in  twelve, 
fifteen,  twenty  or  twenty-six  hours  after  the  invasion 
of  cholera.  Often,  towards  the  close  of  the  disease, 
and  at  the  approach  of  the  most  imminent  danger, 
the  vomitings  and  dejections  diminish,  become  sus- 
pended, and  cease  suddenly. 

The  commencement  of  the  disease  generally  takes 
place  during  the  night  or  in  the  morning ;  the  other 
periods  arrive  with  rapidity,  and  often  with  confu- 
sion— for  we  must  not  expect  any  thing  fixed,  any 
thing  regular,  in  the  midst  of  this  scene  of  disorder 
and  destruction.  In  a  great  number  of  cases,  all 
the  stages  of  the  disease  become  confounded  and 
exhausted  in  a  very  short  space  of  time.  One  or 
two  hours,  at  most,  sometimes  intervene  between 
the  violent  invasion  of  the  disease  and  its  fatal  termi- 
nation. 

The  course  and  series  in  which  the  symptoms 
are  unfolded,  connected,  and  succeed  one  another, 
are  sufficiently  variable  :  sometimes  even  the  most 
prominent  and  most  characteristic  symptoms  are 
entirely  wanting,  and  that  doubtless  because  they 
have  not  been  allowed  time  to  develope  them- 
selves :  such,  for  example,  are  the  vomitings.  We 
find  some  cases  in  which  the  disease  has  pro- 
gressed so  rapidly,  that  in  an  instant  the  individual 
is  found  transported  from  the  state  of  perfect  health 


17 

to  that  fatal  epoch  when  the  vomitings  and  stools 
cease,  because  all  the  vital  operations,  all  the  invol- 
untary movements,  abandon  the  life  which  is  soon 
to  cease  and  be  extinct. 

The  symptoms  in  natives  and  Europeans 
are  the  same.  The  constitution  of  the  individual 
makes  all  the  difference,  according  as,  whether  natu- 
rally or  accidentally,  he  is  found,  in  the  moral  as  in 
the  physical,  either  vigorously  constituted,  or  con- 
siderablv  debilitated. 

By  analysis,  the  catalogue  of  the  symptoms  of  the 
disease  may  be  thus  summed  up  : — 

Epigastric  pains,  repeated  vomitings,  and  frequent 
stools  ;  the  substances,  discharged  at  first,  consisting 
of  aliment  recently  ingested,  soon  become  fluid, 
whitish,  and  flocculent ;  violent  cramps  in  the  supe- 
rior and  inferior  extremities  ;  coldness  of  the  body ; 
suppression  of  urine  ;  the  skin  of  the  extremities, 
of  the  feet  especially,  pale,  moist,  cold  and  wrinkled; 
decomposition  of  the  features ;  hippocratic  counte- 
nance ;  sinkingand  notable  disappearance  of  the  pulse. 

Investigated  in  its  symptomatology,  the  medical 
history  of  the  epidemic  cholera  has  acquired  but 
little  in  the  hands  of  the  physicians  of  Russia.  In 
Russia  and  in  India  the  disease  has  presented  itself 
under  the  same  characters  ;  upon  both  theatres  na- 
ture has  been  faithfully  copied.  Why  then  should 
not  their  descriptions  bear  a  resemblance?  The 
epidemic  influence  acting  upon  almost  every  indi- 

3* 


18 

vidual  exposed  to  it,  even  in  those  in  whom  the 
cholera  was  not  realised';  the  period  of  imminence 
marked,  although  rapidly,  in  many  patients;  the 
choleric  physiognomy  given  as  one  of  the  prominent 
characters  of  the  epidemic ;  the  absence  of  all  fe- 
brile re-action ;  the  frequency  of  relapses :  every 
circumstance  noted  by  the  English  physicians  in 
India,  has  been  exactly  presented  to  the  view  of 
physicians  who  observed  the  disease  in  Russia. 

Here,  however,  we  observe,  in  a  special  manner, 
that  the  cramps  manifested  themselves  in  a  more 
violent  and  obstinate  form  in  women  than  in  men  ; 
and  still  more  so  among  those  who  possessed  a  feeble 
constitution,who  were  subject  to  hysterical  affections, 
or  placed  under  the  influence  of  pregnancy,  whether 
in  its  commencement  or  its  more  advanced  stages. 

The  pulsations  of  the  heart  diminished  to  that 
degree,  that,  even  by  the  ear  or  the  stethoscope, 
its  motion  could  scarcely  be  distinguished ;  and  in 
the  most  severe  cases,  it  was  onlv  the  left  side  of  the 
heart  that  continued  to  contract  slightly ;  the  pulse 
then  disappeared  entirely,  and  could  but  with  diffi- 
culty be  detected  except  in  the  carotids.  In  certain 
cases,  says  M.  Jachnichen,  it  was  only  by  means  of 
the  stethoscope  that  the  respiratory  movements  could 
be  followed.  In  Russia  the  stools  and  vomiting 
were  less  frequent  and  abundant. 

In  Poland,  the  symptomatology  the  same  ;  here 
only  percussion  has  revealed  to  MM.   Briere   de 


19 

Boismont  and  Legallois  a  symptom  which  had  not 
been  so  clearly  mentioned  until  then ;  it  is  the  dull- 
ness in  the  sound  (matite)  of  the  abdomen.  This 
phenomenon,  say  our  observers,  is  particularly  re- 
markable, when  we  compare  it  with  the  sonorous- 
ness of  the  belly  in  individuals  attacked  with  typhus. 
This  dulness  is  explained,  they  add,  by  the  enormous 
accumulation  of  fluids  in  the  intestines.  At  Madras, 
this  state  of  the  abdomen  had  also  been  pointed  out 
by  Annesley. 

By  the  side  of  the  symptomatology  observed  first 
in  India,  then  in  Moscow,  and  finally  at  Warsaw, 
let  us  place  the  symptomatology  described  by 
Aretoeus  of  Cappadocia ;  let  us  translate  it  through- 
out ;  and  let  us  not  fail,  through  the  puerile  appre- 
hension of  being  prolix,  to  be  complete  and  con- 
vincing. 

In  the  cholera,  an  extremely  acute  disease,  says 
Aretoeus,  the  whole  of  the  alimentary  tube  experi- 
ences a  commencement  of  repulsion,  so  that  the 
substances  collected  in  the  stomach  are  violently 
ejected  by  vomiting,  and  those  of  the  intestines 
forcibly  expelled  from  the  anus.  The  matters 
ejected  become  liquid  and  whitish,  and  those  which 
escape  by  the  fundament  are  foetid,  pituitous,  and 
sometimes  bilious.  Soon  abdominal  tension,  pains 
at  the  pit  of  the  stomach,  and  violent  cholics  super- 
vene.   General  spasms  manifest  themselves,  painful 


20 

contractions  in  the  muscles  of  the  legs  and  arms 
ensue  ;  the  fingers  are  curved,  and  the  nails  become 
livid  and  extremely  cold.  There  are  syncope,  ver- 
tigo, oppression  and  hiccup.  The  urine  no  longer 
flows ;  the  voice  is  extinguished  ;  the  pulse  becomes 
extremely  small  and  slow,  and  the  patient  dies  over- 
whelmed with  lacerating  pains,  and  in  the  midst  of 
the  most  horrible  convulsions. 

From  these  conjoined  documents  on  the  subject 
of  the  symptomatology  of  cholera,  the  following 
conclusions  naturally  proceed : 

1.  The  cholera  has  been  observed  at  all  limes,  in 
the  sporadic  state,  in  the  catastatic  state,  in  the  en- 
demic state,  and  in  the  symptomatic  state,  with- 
out ever  having  extended  beyond  the  limits  assign- 
ed to  the  particular  conditions  in  which  they  have 
been  found  to  arise  and  terminate. 

2.  The  epidemic  cholera  observed  in  India  is 
little  else  than  the  cholera  described  by  the  ancients, 
as  to  the  symptomatology. 

3.  The  cholera  which  prevailed  in  Moscow  is  the 
same  as  the  cholera  of  India. 

4.  The  cholera  which  has  occasioned  such  ravages 
in  Poland,  and  especially  in  Warsaw,  does  not  differ 
from  the  cholera  which  raged  at  Moscow. 

Consequently  the  cholera  of  the  ancients,  the 
cholera  of  India,  the  cholera  of  Moscow,  and  the 
cholera  of  Warsaw,  are  identical,  so  far  as  regards 
the  phenomenal  characters. 


PART    SECOND. 


NECROSCOPIC  CHARACTERS. 

It  is  truly  remarkable,  as  we  have  just  seen,  how 
great  is  the  analogy,  agreement,  and  as  it  were, 
identity,  which  the  numerous  descriptions  of  the 
Cholera,  derived  from  the  midst  of  these  different 
regions,  present.  In  Asia,  Persia,  Syria,  in  lower 
Bengal,  Mysore,  and  upon  the  Coromandel  coast, 
in  Russia  and  in  Poland  ;  in  the  authentic  reports 
of  the  medical  societies  of  Bombay,  Calcutta, 
Madras,  of  Moscow  and  of  Warsaw ;  in  the  pub- 
lications of  Annesley,  Ainslie,  Christie,  Scott,  Con- 
veil,  Johnson,  Jameson,  Searle,  Reymann,  Loder, 
Moran,  Jachnichen,  of  Delaunay,  MM.  Briere  de 
Boismont  and  Legallois  :  whether  we  meditate  upon 
its  particular  histories,  or  read  the  general  de- 
criptions,  always,  every  where  and  in  all  authors, 
the  symptomatology  is  concurrent  and  uniform : 
we  mio-ht,  it  would  seem,  from  this  consideration 
alone  deduce  one  of  the  arguments  in  favour  of  the 
certainty  of  medicine. 

It  would   be   well,   indeed,   if  the  same  result 
could  be  obtained  from  the  history  of  its  necros- 


22 

copic  characters.  Whether,  in  consequence  of  the 
nature  of  the  researches,  it  was  necessary  to  sur- 
mount greater  obstacles,  or  that  habit  and  ability, 
zeal,  and  courage,  have  been  wanting  to  observers, 
or  that  pre-conceived  opinions  often  preside  over 
this  part  of  the  subject,  or  that,  lastly,  the  cadav- 
eric lesions  have  been  variable  and  uncertain ;  it 
has  always  been  the  case  that,  upon  this  point,  the 
detail  of  facts  and  the  summary  of  the  investi- 
gations have  often  been  different,  and  sometimes 
even  contradictory. 

In  investigating  this  order  of  the  subject,  there 
is  one  consideration  which  strikes  the  reflecting 
reader ;  it  is,  on  the  one  hand,  the  great  diversity 
and  even  absolute  discrepancy  which  the  results 
furnished  by  pathological  anatomy  present,  when 
we  compare  those  of  one  observer  with  those  of 
another ;  and,  on  the  other  hand,  the  resemblance, 
or  even  uniformity,  of  these  same  results  in  all  the 
particular  cases  related  by  one  and  the  same  ob- 
server. This  is  carried  so  far,  that  Annesley,  who 
without  contradiction,  has  given  one  of  the  best 
descriptions  of  this  disease,  after  having  subjoined 
to  some  of  his  cases  the  pathologico-anatomical 
researches  which  appertained  to  them,  discon- 
tinues the  further  detail  of  autopsic  examinations, 
contenting  himself  with  declaring,  that  the  anatomic- 
al appearances  were  the  same  as  in  the  preceding 
cases. 


23 

With  these  reflections,  which  may  be  subservient 
in  estimating  the-  value  of  the  works  we  are 
about  to  examine,  we  may  say  in  general  that,  on 
the  continent  of  Asia,  the  researches  of  pathologic- 
al anatomy  have  presented,  sometimes  the  altera- 
tions, the  anatomical  characters  of  gastro-intestinal 
phlegmasia,  and  sometimes  a  simple  catarrhal  state 
without  any  trace  of  inflammation  of  the  mucous 
membrane  of  the  intestines.  In  some  cases  cere- 
bral congestions  and  considerable  injections  of  the 
vessels  of  the  brain  and  its  membranes  have  been 
noted ;  in  others,  lesions  of  the  spinal  marrow  and 
its  envelopes.  In  many  circumstances  pathological 
anatomy  has  developed  nothing  which  could  afford 
a  sufficient  reason  for  the  symptoms  of  the  disease 
and  its  termination  ;  and  then  it  has  almost  always 
been  attributed  to  a  lesion  of  the  vital  properties  of 
the  nervous  system. 

Let  us  enter,  however,  into  the  details  of  these 
researches ;  it  is  the  only  way  in  which  we  can  com- 
prehend and  duly  appreciate  them. 

Doctor  Annesley  finds,  from  autopsic  investiga- 
tion that  the  intestines  present  a  vermillion  colour, 
which,  he  says,  is  peculiar  to  the  disease,  and  which 
he  considers  as  characteristic  of  Cholera. 

He  attributes  the  same  importance  to  a  gelatin- 
ous extravasation,  to  a  yellowish,  pultaceous,  and 
as  it  were  creamy,  matter,  which  adheres  to  seve- 


24 

ral  points  of  the  internal  surface  of  the  small  intes- 
tines, and  which  is  there  met  with  in  variable 
quantities, 

According  to  him,  the  substance  of  the  heart  is 
softer  and  more  easily  lacerated  than  it  generally 
is  in  bodies  dead  from  other  diseases.  The  cavi- 
ties of  this  organ,  as  well  as  the  principal  arterial 
and  venous  truncks,  are  filled  with  a  thick  and 
viscid  black  blood. 

The  primary  and  principal  strokes  of  the  disease 
are  directed,  says  Mr.  Annesley,  upon  the  nervous 
system,  the  lesion  of  which  immediately  re-acts 
upon  the  sanguineous  system. 

Doctor  Alexander  Gordon,  a  surgeon  attached 
to  the  Bombay  Presidency,  a  man  of  distinguished 
merit,   and   who    fell   a   victim   to  the   epidemic, 
asserts  in  a  memoir  addressed  to  the  medical  so- 
ciety of  Bombay  that,  in  this  epidemic,  the  lesions 
of  the  brain  were  primitive  and  essential,  whilst 
those  of  the  intestines  were  only  secondary.     In 
the  first  subjects  which  he  examined,  he  had  ne- 
glected to  examine  the  brain,  and  then  he  could 
not  discover  any  thing  which  could  satisfactorily 
account  for  the  violent  nature  of  the  disease.     Af- 
terwards he  extended  his  investigations  also  to  the 
encephalon,  and  he  there  found  the  vessels  injected 
and  the  membranes  thickened :  these  lesions,  how- 
ever, did  not  seem  to  him  to  be  at  all  inflammatory. 


25 

Doctor  Scott,  secretary  to  the  Medical  Board  of 
the  Presidency  of  Madras,  regards  these  lesions  of 
the  brain,  on  the  contrary,  as  secondary  and  acces- 
sory, since  the  intellectual  faculties  generally  remain 
perfect  during  the  course  of  the  disease.  In  the 
opinion  of  Dr.  Scott,  it  is  in  the  mucous  membrane 
of  the  intestines  that  the  important  facts  of  patho- 
logical anatomy  peculiarto  the  cholera  are  developed. 

That  if  the  patient  is  seized  with  coma,  if  we 
observe  in  him  that  extreme  degree  of  torpor,  into 
which  individuals  attacked  by  this  disease  fall,  if 
he  is  entirely  unconscious  of  whatever  is  passing 
around  him — it  is  to  debility,  says  Dr.  Scott,  that 
we  must  attribute  these  symptoms. 

Kennedy,  the  author  of  a  work  ex  professo,  upon 
the  Indian  Cholera,  pretends  that  this  disease  con- 
sisting merely  in  a  considerable  alteration  of  the 
vital  functions  of  the  nerves,  the  system  of  the 
circulation  is  but  secondarily  affected.  There  is  in 
the  Cholera,  according  to  his  views,  some  occult 
cause  which  retains  the  vital  powers  in  a  state  of 
violent  oppression  ;  in  a  word,  says  he,  the  Cholera 
consists  in  a  more  or  less  forcible  concussion  of  the 
encephalon,  a  concussion,  the  form  of  which  is 
entirely  unknown  to  us. 

The  information  derived  from  the  autopsic  ex- 
aminations of  those  physicians  who  observed  the 
Cholera   at   Samarang,  sheds   no   light  upon   the 

4 


26 

the  nature  of  this  disease.  It  is  scarcely  worth 
while  to  make  mention  of  the  very  slight  traces 
of  inflammation  scattered  over  the  intestines,  and 
still  less  do  we  deem  it  necessary  to  notice  the 
bloody  froth  with  which  the  bronchia  were  filled  in 
many  cases,  the  contraction  and  vacuity  of  the  blad- 
der, or  the  injected  vessels  of  the  brain  and  its 
membranes.  The  physicians  who  have  studied  the 
disease  in  Samarang,  have  consequently  inferred, 
that,  as  to  its  primary  cause,  it  consists  in  a  vi- 
olent spasmodic  affection  of  the  digestive  organs, 
and  more  especially  of  the  stomach  and  duodenum. 
M.  Mouet,  surgeon-general  of  the  24th  regiment 
of  his  Britannic  Majesty,  and  who  has  given,  in  the 
collection  of  the  Philosophico-Medical  Society  of 
Calcutta,  a  very  valuable  work  on  the  Cholera,  de- 
clares that  most  frequently  the  opening  of  bodies 
does  not  furnish  any  information  of  importance. 
Sometimes,  says  he,  we  found,  either  in  the  intes- 
tines, or  in  the  encephalon,  the  vessels  considerably 
injected ;  at  other  times  such  injections  scarcely 
existed,  or  even  were  not  at  all  perceptible.  In 
two  cases,  in  particular,  wherein  the  patients  were 
attacked  with  coma  and  violent  delirium,  he  found 
nothing  in  the  brain,  notwithstanding,  he  adds,  the 
autopsy  was  always  conducted  with  the  most  scru- 
pulous exactness.  It  was  in  three  subjects  only 
that   he  discovered  the  pultaceous  matter  which 


27 

Doctor  Annesley  was  the  first  to  notice  in  this 
disease,  a  matter  which  he  says  is  constant,  and 
which  he  regards  as  the  specific  cause  and  conse- 
quently as  the  pathognomonic  sign  of  Cholera. 

Dr.  Turnbull  Christie,  attached  to  the  Medical 
establishment  of  Madras,  and  quite  recently  ap- 
pointed to  take  charge  of  the  civil  medical  depart- 
ment for  the  district  south  of  Maratta,  in  an  original 
and  valuable  work,  entitled  Observations  on  the  na- 
ture and  treatment  of  the  Cholera,  and  the  manner 
in  which  it  affects  the  mucous  membranes,  has  freely 
investigated  its  pathological  anatomy.  His  obser- 
vations, collected  during  ten  consecutive  years  and 
especially  in  those  of  1823  and  1824,  as  well  upon 
the  soldiers  of  his  Britannic  Majesty's  regiments  as 
upon  the  natives  of  cities  and  country  villages,  and 
the  frequent  opportunities  which  he  has  had  of 
seeing  the  disease  in  prisons,  have  favoured  him 
with  facilities  of  opening  numerous  dead  bodies, 
which  are  but  with  great  difficulty  obtained  among 
the  free  natives.  During  the  year  of  1826  alone 
the  total  number  of  deaths  in  the  whole  district 
of  Darwar,  amounted  to  three  thousand  and  fifty- 
three.  We  have  not,  however,  any  data  upon 
the  fixed  population  of  this  district. 

The  mucous  system,  according  to  the  opinion  of 
Doctor  Christie,  is  the  incontestable  seat  of  the  dis- 
ease.   This  system,  an  exception  to  all  others,  is 


28 

susceptible  of  two  forms  of  lesion :  the  inflammatory 
form,  which  is  common  to  it  with  all  the  other  tis- 
sues, and  the  catarrhal,  which  is  peculiar  to  it 
alone.  The  catarrhal  form  is  entirely  distinct  from 
the  inflammatory.  In  the  mucous  tissue  they 
generally  exist  separately,  but  often  they  are  also 
united  and  complicated  with  one  another.  The 
catarrhal  form,  by  being  prolonged  with  a  certain 
degree  of  activity,  ushers  in  the  developement  of 
the  inflammatory  form.  These  results  of  facts  are 
illustrated  by  the  symptomatology  compared  with 
that  of  many  other  diseases,  by  the  action  of  med- 
icines on  man  and  animals,  and  by  direct  ex- 
periments made  upon  the  latter,  as  well  as  from 
certain  vivisections.  The  inflammatory  state  of  the 
mucous  tissue  does  not  differ  from  what  takes  place 
in  inflammation  in  general ;  but  the  catarrhal  state 
is  a  specific  diseased  affection  of  the  secretory  ap- 
paratus of  the  mucous  membranes,  whence  result 
the  augmentation  and  alteration  of  the  secretion. 
Then  the  mucous  membrane  is  white  without  pain, 
without  tumefaction  ;  there  is  a  diminution  in  the 
propulsion  of  the  blood  to  the  circumference.  It 
is  pretty  generally  advanced,  says  Dr.  Christie,  that, 
in  the  Cholera,  pathological  anatomy  unfolds  nothing 
which  can  satisfactorily  account  for  the  disorders 
which  exist  during  life.  An  opinion  like  this,  he 
adds,  can  only  proceed  from  the  carelessness  of  the 


29 

researches.  The  mucous  membranes  have  not  been 
studied  with  sufficient  attention :  some  physicians 
have,  doubtless,  examined  with  care  the  secretions 
furnished  by  the  mucous  system  :  but  there  are 
few,  or  indeed  none,  who  have  properly  studied 
the  lesions  of  the  membranes  which  furnish  these 
secretions. 

It  is  in  vain  that  we  search  in  the  encephalon,  the 
nervous  system,  or  in  the  sanguineous  system  for 
the  anatomical  lesions  of  Cholera :  it  is  invariably 
to  the  mucous  system  that  these  lesions  belong ;  all 
others  are  merely  accidental  or  secondary. 

I  have  constantly  found,  again  says  M.  Christie, 
in  my  very  numerous  dissections,  an  opaque,  viscid, 
whitish  substance  adhering  to  the  surface  of  the  in- 
testinal mucous  membranes ;  and  in  some  cases  this 
substance  was  so  abundant  as  to  fill  the  intestines 
completely.  The  membrane  was  white  and  smooth 
throughout  its  whole  extent.  Similar  alterations 
have  sometimes  existed  in  the  pulmonary  mucous 
membrane,  and  even  in  the  bladder. 

The  anatomical  lesions  which,  in  regard  to  fre- 
quency, may  be  ranked  in  the  second  order,  are, 

1st,  Venous  congestions  of  several  organs,  and 
especially  of  the  abdominal  viscera ; 

2d,  Accumulations  of  thick,  black  blood  in  all 
the  vessels,  and  especially  in  the  heart ; 

3d,  Traces  of  injections  upon  some  points  of  the 

4* 


30 

mucous  membranes,  and  especially  of  the  intes- 
tines. In  these  cases  the  inflammation,  when  it  did 
exist  was  found  confined  to  the  pyloric  extremity 
of  the  stomach  and  the  small  intestines. 

4th.  Simple  venous  congestions  in  various  points, 
such  as  have  been  noticed  by  Doctor  Annesley. 

Resuming  the  consideration  of  the  secretions  ot 
the  mucous  membrane,  Dr.  Christie  demonstrates 
that  they  are  not  only  increased  in  quantity,  but 
that  they  are  likewise  altered  and  depraved  in  qual- 
ity ;  and  brings  forward  a  great  number  of  chym- 
ical  analyses  and  physical  experiments  to  substan- 
tiate the  fact.  The  author  has  especially  very 
positively  proved  that  no  free  acid  exists  in  the  sub- 
stance of  these  secretions;  thus,  says  he,  does  the 
opinion  promulgated  by  Dr.  Ainslie  upon  the  path- 
ogeny of  the  epidemic  cholera  fall  to  the  ground. 

Whitelaw  Ainslie  has  resided  during  thirty  years 
at  Madras  and  in  several  parts  of  southern  India, 
in  the  capacity  of  physician  and  member  of  the 
committee  deputed  to  investigate  the  epidemic  chol- 
era. He  considers  the  lesions  indicated  by  path- 
ological anatomy  as  of  but  trivial  importance  ;  he 
knows  them  all,  he  has  seen  them  all.  The  essence 
of  the  disease,  in  his  opinion,  resides  in  a  free  acid 
the  existence  of  which  he  has  detected  in  the  sub- 
stances discharged  by  stool  and  by  vomiting ;  and 
hence  he  derives  all  his  opinions  relative  to  the  na- 


31 

ture  of  the  disease,  its  indications  and  its  method  of 
treatment. 

James  Boyle,  from  three  autopsic  examinations 
only,  signalizes  slight  traces  of  inflammation  in  the 
stomach  and  intestines ;  he  lays  great  stress  upon 
this  order  of  considerations,  and  roundly  asserts 
that  the  pathological  anatomy  of  cholera  always 
furnishes  similar  results. 

At  the  isle  Saint-Maurice,  M.  Guillemau  thus 
renders  an  account  of  his  necroscopic  observations. 
It  is  to  the  interesting  work  of  our  colleague  M. 
Keraudren  that  we  are  indebted  for  this  communi- 
cation. 

Encephalon  healthy  ;  lungs  in  the  normal  state  ; 
right  cavity  of  the  heart  full  of  a  blackish  blood,  left 
cavity  empty :  the  stomach  presenting  diverse  alter- 
ations ;  phlogosis  and  injection  of  the  vessels ;  the 
mucous  membrane  sometimes  destroyed  in  different 
points  and  especially  near  its  orifices,  which  are 
sometimes  apparently  contracted:  this  organ  had 
preserved  its  liquids  almost  unchanged.  The  small 
intestines  were  in  general  healthy,  whilst  the  tunics 
of  the  large  intestines  were  thickened.  The  latter 
phenomena  presented  the  greater  intensity  in  pro- 
portion as  the  disease  had  been  the  more  pro- 
longed. 

Doctor  Labrousse  thus  gives  the  result  of  the 
autopsic  examination  of  twelve  blacks,  all  of  whom 


32 

died,  in  the  space  of  twelve  hours,  from  the  epi- 
demic of  the  isie  of  Bourbon. 

After  death,  the  body,  without  any  appearance  of 
putrefaction,  was  generally  emaciated,  very  meagre, 
notwithstanding  the  constitution  of  the  patients  had 
been  very  robust. 

In  some  the  brain  had  undergone  no  change  ; 
whilst  in  others  its  substance  was  found  softer  than 
in  the  ordinary  state.  The  longitudinal  sinus  was 
gorged  with  blood,  and  the  lateral  ventricles  con- 
tained a  small  quantity  of  sanguineous  serosity. 

The  lungs  were  sound ;  the  pericardium  contain- 
ed a  little  serum  ;  the  heart  was  slightly  enlarged  ; 
the  coronary  vessels  were  always  filled  with  a  very 
black  and  coagulated  blood :  no  adhesion  was  ob- 
served in  th's  cavity. 

The  gastro-colic  epiploon,  and  the  internal  sur- 
face of  the  intestines  as  well  as  the  mesentery,  pre- 
sented a  slight  degree  of  inflammation  and  a  great 
repletion  of  their  vessels. 

The  gall  bladder,  very  much  distended,  contain- 
ed a  thick  and  blackish  bile.  The  hepatic,  cystic 
and  choledic  ducts  were  twice  their  natural  size  ; 
the  spleen,  pancreas  and  kidneys  presented  nothing 
peculiar.  The  bladder  wras  greatly  contracted  and 
in  a  state  of  complete  vacuity.  The  stomach,  dis- 
tended with  gas,  was  otherwise  empty  in  several ; 
in  others  it  contained  a  greyish  white  viscid  fluid 


33 

and  some  worms.  The  gastro-intestinal  mucous 
membrane,  sound  in  some  individuals,  presented  in 
others  an  intense  inflammation  which  increased  from 
the  pylorus  to  the  rectum.  The  other  tunics  par- 
ticipated in  this  inflammation,  with  the  exception 
of  those  of  the  jejunum  and  ileum. 

Their  cavity  enclosed  a  sero-purulent  liquid  and 
sometimes  lumbrici. 

The  examination  of  the  bodies  often  other  blacks, 
who  died  in  the  first  four  days  of  the  disease,  pre- 
sented nearly  the  same  phenomena  in  the  three  cav- 
ities, unless  it  was  that  the  inflammation  was  more 
intense.  Gangrenous  spots  were  then  observed  in 
the  small  intestines,  and  the  substances  contained 
in  their  cavity  seemed  to  be  the  same  with  those  of 
the  dejections. 

Under  certain  circumstance?,  the  examinations 
of  the  bodies  of  those  who  have  died  in  consequence 
of  cholera,  have  exhibited  invaginations  of  the  in- 
testines, partial  ulcerations  and  even  gangrene.  But 
these  can  only  be  considered  as  accidental  occur- 
rences and  exceptions ;  they  should  be  noticed  how- 
ever in  order  that  our  researches  may  be  rendered 
complete  :  but  it  should  be  mentioned  that  these 
lesions  have  rarely  been  detected,  and  that  it  is  not 
in  the  most  severe  and  most  promptly  fatal  cases 
that  they  have  been  remarked. 


34 

From  the  observations  of  writers  on  the  Indian 
cholera,  two  original  opinions,  in  relation  to  its 
pathological  anatomy,  are  derived  which  merit  a 
particular  examination. 

The  first,  represented  by  Annesley,  who  if  he 
did  not  discover  it  has  at  least  supported  it  with 
eclat,  is  characterised  by  making  the  cholera  consist 
in  a  coloration  of  the  intestines,  the  tint  of  which 
varies  from  a  bright  vermillion  to  a  deep  purple, 
and  in  the  secretion  of  a  whitish,  viscid,  and  opaque 
pultaceous  matter.  This  coloration  is  particularly 
remarkable  upon  the  peritoneal  surface  of  the  duod- 
enum and  jejunum.  What  need  is  there  of  insist- 
ing much  on  this  coloration  ?  On  the  one  hand,  it 
is  necessary  that  the  existence  of  these  reddish  ap- 
pearances should  have  been  confirmed  by  every 
observer ;  a  great  many,  however,  have  denied 
their  existence ;  and,  on  the  other  hand,  in  how 
many  cases  of  different  acute  diseases  have  these 
reddish  appearances,  these  injections  not  been  ob- 
served ?  This  lace-work  of  small  injected  vessels 
is  almost  always  discovered  after  death,  especially 
when  but  a  very  short  space  of  time  elapses  between 
the  decease  and  the  opening  of  the  body.  How 
can  any  transient  red  appearances,  or  partial  injec- 
tions of  the  intestinal  mucous  membrane,  so  little 
in  relation  with  the  general  symptomatology,  the 
rapid  progress,  and  fatal  termination  of  the  disease, 


35 

be  seriously  invoked  as  causes  of  the  epidemic 
cholera  ? 

The  second  original  opinion,  among  physicians 
who  have  attended  the  disease  in  Asia,  appertains 
almost  exclusively  to  Doctor  Christie.  In  the 
opinion  of  this  physician,  the  mucous  system  is  the 
principal  seat  of  epidemic  Cholera,  and  it  is  a 
catarrhal  state  of  this  system  which  constitutes  the 
special  modification  of  it :  this  modification  is,  in 
its  turn,  nothing  else  than  the  increased  and  vitiated 
action  of  the  secretory  vessels  of  the  mucous  mem- 
brane, andanextraordinaryalteration  in  thesecretion. 
Dr.  Christie  has  almost  uniformly  found  the  mucous 
membrane  of  the  intestines  pale,  white,  softened, 
doughy,  very  lacerable,  and  coated  with  a  large 
quanity  of  a  whitish,   viscid,  opaque,  creamy  fluid. 

These  facts,  which  in  themselves  are  of  the  high- 
est importance,  and  which  have  been  likewise  con- 
firmed by  many  observers,  are  nevertheless  present- 
ed in  a  manner  too  general,  too  exclusive,  by  Doctor 
Christie.  Without  doubt  these  conditions  of  the 
mucous  system  exist  in  many  cases  of  Cholera,  but 
they  are  not  in  themselves  alone  the  entire  disease. 
In  the  normal  state,  the  intestinal  mucous  mem- 
brane is  also  pale,  white  and  soft ;  the  only  differ- 
ence then  is  in  degree,  and  this  softening  of  the 
internal  mucous  tunic  is  far  from  constantly  pre- 
senting  itself  in  the    autopsic  examinations    con- 


36 

sequent  upon  Cholera.  The  mucous  follicles,  the 
glands  of  Peyer  and  Brunner,  specially  destined  for 
the  secretion  of  the  intestinal  mucous  fluids,  are 
without  any  material  lesion  in  the  Cholera,  notwith- 
standing their  functions  have  been  manifestly  im- 
paired. In  the  catarrhal  state  the  occurrences 
which  take  place  are  decidedly  opposed  to  those 
which  ensue  in  consequence  of  the  inflammatory 
state  of  the  latter  organs. 

From  the  labours  of  Christie,  it  appears  that  the 
existence  of  a  catarrhal  affection,  as  an  integral 
part  of  the  Cholera,  cannot  be  doubted ;  but  on 
the  other  hand,  this  opinion,  entirely  exclusive, 
cannot  be  admitted  as  such. 

The  history  of  the  necroscopic  characters  has  not 
been  less  elaborated  by  the  physicians  who  have 
engaged  the  epidemic  upon  the  soil  of  Russia.  In 
the  numerous  documents  which  have  reached  us 
from  this  country  we  find,  in  the  first  place,  many 
of  the  general  results  of  autopsic  examinations  ;  and 
these  results,  variable,  uncertain  and  superficial,  do 
not  present  any  character  which  has  not  been  de- 
veloped in  the  researches  of  pathological  anatomy, 
consequent  upon  some  other  diseases ;  none  of 
which  can  enlighten  us  as  to  the  nature  of  the  dis- 
ease, or  unveil  to  us  the  cause  of  its  rapid  march 
and  fatal '  terminations. 


37 

Let  us  see  how  M.  Surgeon  Major  Sokolow 
expresses  himself  upon  this  point,  in  his  interesting 
work  on  the  epidemic  observed  at  Orenburg. 

All  anatomical  researches  made  upon  the  bodies 
of  those  who  have  fallen  victims  to  the  Cholera, 
whether  at  the  commencement  of  the  epidemic 
or  towards  its  close,  and  repeated  as  often  as  any 
peculiarities  in  the  symptoms  or  unusual  violence 
and  rapidity  in  the  disease  served  to  attract  at- 
tention, may  be  reduced  to  the  following  particulars : 
tension  of  the  skin  ;  flexibility  of  the  muscles,  at 
least  during  the  twenty-four  hours  immediately  suc- 
ceeding death ;  a  certain  flaccidity,  a  softness  of 
the  muscles,  and  rapid  tendency  of  the  bodies  to 
putrefaction. 

In  the  cavity  of  the  cranium,  we  uniformly  found 
a  great  collection  of  thick  black  blood,  extravasated 
between  the  convolutions  of  the  cerebral  substance, 
and  a  distension,  a  repletion  both  of  the  veins  of  the 
brain  itself  and  of  the  arachnoid. 

The  lungs  were  flaccid  and  filled  with  a  thick  and 
black  blood  ;  such  was  also  the  appearance  of  the 
heart,  which  in  some  cases  presented,  internally,  pol- 
ypiform  concretions.  This  last  character  was  par- 
ticularly remarked  in  the  bodies  of  those  individuals 
who  died,  after  the  termination  of  Cholera,  of  lethar- 
gic fever  with  stupor.  The  abdomen  never  pre- 
sented adhesions,  extravasation  or  meteorism.     The 

5 


38 

peritoneum,  mesentery,  and  omenta  preserved  their 
normal  state ;  their  blood-vessels  however  were  more 
distended  with  blood  than  ordinarily.  The  stomach 
and  intestines  presented,  as  wrell  at  their  internal  as 
upon  their  external  surface,  reddish  streaks,  similar 
to  inflamed  scratches,  which  extended  longitudinally. 
Internally,  the  intestines  were  covered  with  brownish 
and  pretty  viscid  mucosities.  After  having  washed 
away  these  mucosities,  we  perceived  that  the  thick 
reddish  streaks  of  the  stomach  and  intestinal  canal, 
and  especially  of  the  small  intestines,  presented 
neither  gangrenous  appearance,  nor  that  purplish 
redness  which  characterises  a  decided  inflammation. 
Injections  of  thick  blood  were  particularly  manifest 
in  the  venous  ramifications  of  the  stomach  and  liver; 
the  gall-bladder  was  injected  and  filled  with  a  con- 
siderable quantity  of  bile.  The  spleen  was  some- 
times healthy,  but  more  generally  turgid  and  very 
lacerable.  The  kidneys  differed  but  little  from 
the  natural  state;  the  bladder  was  always  empty 
and  contracted.  We  have  not  in  any  corpse  found 
the  least  trace  of  gangrene. 

Doctor  Meusnier,  Physician  of  the  Faculty  of 
Paris,  Consular  Agent  of  France  at  Tangaroc,  where 
he  has  observed  the  disease,  in  his  letter  to  the 
Academy  upon  the  Cholera,  thus  expresses  himself: 

"  The  disease  is  decidedly  an  inflammatory 
epidemic;  the  necropsy  has  exhibited  (especially 


39 

in  those  who  perished  rapidly)  very  violent  inflam- 
mation of  the  epiploon,  of  the  small  intestine,  and 
of  some  parts  of  the  stomach  ;  the  gall-bladder  but 
partially  distended,  and  usually  containing  a  deep- 
coloured  and  thick  bile  ;  a  deep  coloration  of  the 
muscles  in  all  their  fibres,  a  coloration  which  I  have 
never  seen  so  strongly  marked  in  other  cases  of 
necropsy,  consequent  to  death  proceeding  from 
other  diseases." 

Doctors  Jachnichen  and  Marcus  have  published  a 
collection  of  forty  cases  of  Cholera,  followed  by 
autopsic  examinations  carefully  made  and  exposed 
with  the  minutest  details.  Let  us  first  hear  M. 
Marcus'  description  of  these  researches  in  patho- 
logical anatomy. 

We  have  found,  says  M.  Marcus,  that  a  black 
blood  filled  not  only  the  cavities  of  the  heart,  but 
also  many  of  the  arteries,  especially  the  arteries 
proper  to  the  heart  and  those  of  the  base  of  the  en- 
cephalon  ;  besides,  there  were  constantly  certain 
fibrous  polypous  concretions  in  the  cavities  of  the 
heart,  and  also  some  signs  of  irritation  and  appa- 
rent inflammation  over  points  of  this  organ. 

We  have  also  directed  our  attention  to  the  patho- 
logical state  of  the  envelopes  of  the  spinal  marrow 
and  of  the  coverings  of  the  brain,  the  whole  of  the 
medullary  substance  of  which  was  found  healthy, 
and  we  have  seen  that  the  first  were  more  frequent- 


40 

]y  in  a  pathological  state  than  the  second.  Lastly, 
we  have  found  that  the  intestinal  tube  not  only  did 
not  present  uniform  characters,  but  that  it  even 
presented  those  which  were  contradictory. 

We  have  been  led  to  conclude  that  the  alterations 
in  the  gastro-intestinal  system  have  only  been  con- 
secutive and  accidental ;  that  those  of  the  encepha- 
lon,  although  much  more  important,  were  not  how- 
ever characterised  by  a  disturbance  of  functions  by 
any  means  so  great  as  that  which  obstructed  the 
movement  of  the  heart  during  life  ;  that,  conse- 
quently, the  phenomena  presented  by  the  heart,  such 
as  the  accumulation  of  a  black  blood  in  its  cavities 
and  in  the  arteries,  together  with  the  fibrous  concre- 
tions, were  the  most  constant  anatomical  characters. 

The  stomach  and  intestines,  says  MM.  Briere  de 
Boismont  and  Legallois,  contained  a  considerable 
quantity  of  a  whitish  serous  fluid.  After  the  escape 
of  this  fluid,  we  found  the  mucous  membrane  gen- 
erally coated  with  a  white,  creamy  substance  :  the 
thickness  of  the  intestinal  tunics  was  sensibly  aug- 
mented, and  they  gave  under  the  fingers  a  clammy 
sensation  ;  they  were  of  a  remarkable  whiteness, 
and  presented  only  a  slight  linear  injection,  oc- 
cupying the  most  dependent  portion  of  the  intestine. 
Incertain  cases,  the  digestive  canaldidnotenclose  any 
serosities ;  but  it  was  almost  every  where  lined  with 
a  faded  white  matter,  opake,  viscid  and  adherent  to 


41 

the  membranes.  The  latter  were  sometimes  of  an 
extraordinary  whiteness,  at  other  times  highly  in- 
jected. Sometimes  the  white  matter  was  also  found 
in  the  bladder,  but  in  variable  quantity.  In  gen- 
eral, the  spleen  was  small,  the  liver  healthy  and  the 
gall-bladder  moderately  distended  with  a  thick 
deep-coloured  bile.  The  other  organs  presented 
nothing  peculiar. 

The  works  on  the  pathological  anatomy  of  Epi- 
demic Cholera,  published  in  Russia,  considered  in 
relation  to  the  original  or  new  data  which  they 
present,  reduce  themselves,  as  we  perceive,  thus 
far,  to  the  four  decadal  publications  of  M.  Marcus 
and  his  colleagues. 

These  forty  cases,  all  of  which  are  followed  by 
autopsic  examinations,  carefully  performed  and  mi- 
nutely detailed,  are  so  much  the  more  entitled  to 
particular  attention,  inasmuch  as  being  collected  by 
three,  four  or  five  physicians,  these  facts  are  pre- 
sented with  a  degree  of  authenticity  which  many  of 
the  others  do  not  possess. 

To  recapitulate.  These  forty  cases  present  two 
circumstances  which  would  at  first  sight  seem  to 
deserve  examination.     These  are  : — 

1st.  Deep  spots,  resembling  ecchymoses,  upon 
the  external  surface  of  the  heart  and  at  its  posterior 
part ;  the  different  cavities  of  the  heart,  and  the 
large  trunks  which  proceed  from  it  containing,  in 

5* 


42 

all  the  cases,  a  great  quantity  of  gelatiniform  or  even 
polypiform  blood : 

2d.  Considerable  injections  of  the  dura  mater, 
and  sometimes  also  of  the  pia  mater;  the  brain 
dotted  with  blood,  and  the  spine,  in  some  cases, 
containing  a  certain  quantity  of  sanguinolentserosity; 
the  pia  mater  most  usually  injected  to  a  remarkable 
degree  ;  the  spinal  marrow  softened  in  several 
points  of  its  extent. 

The  accumulation  of  blood  in  the  heart  and  large 
vascular  trunks  it  would  seem  should  first  attract 
attention,  and  with  so  much  the  more  propriety, 
because  this  fact,  in  India  as  well  as  in  Russia,  has 
been  noticed  by  almost  every  observer.  But  can 
this  accumulation  of  blood  truly  constitute  a  cadav- 
eric lesion  to  which  we  should  attribute  the  epidemic 
cholera  ?  The  blood  does  not  seem  to  have  pre- 
sented any  sensible  alteration ;  and  in  fine,  there 
has  merely  been  discovered  what  is  observed  in  all 
acute  diseases  when  they  run  rapidly  to  a  mortal 
termination.  This  state  is,  without  any  doubt,  the 
normal  state  of  the  heart  and  larger  vessels,  ac- 
cording to  the  general  and  most  approved  notions 
of  pathological  anatomy. 

And,  as  it  regards  those  ecchymoses  of  the  exter- 
nal and  posterior  surface  of  the  heart,  what  can  we 
say  of  a  lesion  which  is  not  found  mentioned  by  any 
other  observer,  and  which,  even  in  the  examinations 


43 

made  by  M.  Marcus  and  his  colleagues,  were  only 
detected  in  nine  subjects  out  of  forty  ? 

Of  all  the  lesions  pointed  out  by  M.  Marcus,  the 
most  important  is,  without  contradiction,  the  soft- 
ening of  the  spinal  marrow,  especially  as,  out  of 
forty  facts  collected,  this  softening  has  been  ob- 
served nineteen  times ;  and  we  might  say  that,  if 
elsewhere,  and  by  other  observers,  this  phenome- 
non has  not  been  noticed,  it  is  because  the  re- 
searches necessary  for  ascertaining  it  were  not 
made,  since  the  spine  has  but  very  rarely  been 
opened,  and  even  where  it  has  been,  it  was  seldom 
with  attention  and  desirable  precaution. 

On  the  other  hand,  however,  we  may  remark 
that  this  lesion  has  only  been  observed  in  the  moi- 
ety, at  most,  of  the  subjects  opened  ;  that  the 
alteration  might  be  the  result  of  manoeuvres  em- 
ployed in  order  to  examine  the  spine ;  and  that 
the  disease  has  neither  been  more  violent,  more 
rapid,  nor  more  fatal  in  those  subjects  in  whom 
this  softening  has  been  discovered,  than  in  those  in 
whom  it  was  not  detected.  From  these  different 
considerations  we  must  naturally  deduce  the  fol- 
lowing conclusions : 

1st.  The  various  anatomical  lesions,  observed  af- 
ter death  caused  by  the  epidemic  Cholera,  have 
nothing  exclusive,  nothing  proper  to  this  disease. 


44 

2d.  These  lesions  are  not  more  constant  as  to 
their  seat  than  as  to  their  nature. 

3d.  These  lesions  have  no  relation  of  causation, 
either  with  the  disease  or  with  the  death,  in  Chol- 
era ;  they  can  only  be  considered  as  more  or  less 
accidental,  more  or  less  remote  consequences. 

4th.  Neither  the  seat  nor  the  nature  of  epi- 
demic Cholera  have  derived  satisfactory  elucida- 
tion from  pathological  anatomy,  notwithstanding 
the  researches  and  endeavours  of  the  great  num- 
ber of  enlightened  men  who  have  been  engaged 
in  them. 

If  we  now  turn  back  to  what  has  been  done 
with  regard  to  the  pathological  anatomy  of  Cholera 
prior  to  the  epidemic  of  India,  we  will  learn  that 
Celsus,  from  the  symptomatology  alone,  had  pre- 
dicted the  difficulty  of  assigning  a  determinate  ana- 
tomical seat  to  the  Cholera-morbus. 

•'  Cholera"  says  he,  "  inter  intestina  stomachum- 
que  versatur  :  ita  lit,  cajus potissimum partis  sit,  non 
facile  did  queat." 

We  must  arrive,  however,  at  the  commencement 
of  the  seventeenth  century  in  order  to  meet  wTith 
concise  anatomical  annotations  upon  the  peculiar 
lesion  of  Cholera. 

Diemerbroeck  places  the  seat  of  Cholera  in 
the  gall  bladder,  which  he  has  found  filled  and  dis- 
tended with  bile. 


45 

Dolaeus  and  Bartholin  attribute  the  Cholera  to 
gangrene  of  the  small  intestines  and  pyloric  orifice 
of  the  stomach.  These  two  anatomists  have,  more- 
over, found  the  stomach  and  intestines  tinged  ex- 
teriorly a  deep  yellow  colour. 

Riolan  affirms  that  the  liver  is  dessicated,  and 
indurated,  and  that  the  gall-bladder  as  well  as 
biliary  ducts  very  much  dilated. 

Bonetus  considers  the  Cholera  as  a  disease  of 
the  liver,  when  it  is  not  occasioned  by  poison. 

Mons.  Portal  coincides  with  the  opinions  of 
Bonetus. 

Hence  it  results  that  the  Cholera,  so  far  as 
relates  to  its  necroscopic  character,  has  received, 
neither  previous  to  the  epidemic  of  India,  nor  dur- 
ing this  fatal  occurrence,  nor  since,  any  impor- 
tant elucidation,  notwithstanding  the  numerous 
works  published  on  this  subject,  both  in  Asia  and 
Europe. 

Hence,  thus  far,  the  epidemic  Cholera  has  no 
positive,  definite,  or  fixed  character ;  and  if  it  is 
possible  to  discover  the  true  seat  of  this  malady,  if 
we  may  retain  the  hope  of  ascertaining  its  na- 
ture, we  must  seek  elsewhere  than  in  pathological 
anatomy  for  that  information  which  will  enable  us 
to  obtain  this  important  result. 


PART  THIRD. 


NATURE  OF  THE  DISEASE. 

Since,  in  the  endeavour  to  ascertain  the  seat  and 
nature  of  epidemic  Cholera  by  the  light  of  patho- 
logical anatomy,  we  have  failed  in  our  object,  let  us 
see  whether  its  symptomatology  will  not  serve  us 
as  a  better  guide. 

In  the  first  place  let  us  examine  that  remarkable 
impression  which  the  epidemic  stite  prcduces  upon 
the  general  organization.  Every  where  has  this  in- 
fluence been  observed.  In  India,  as  well  as  in  Rus- 
sia and  Poland,  physicians  of  every  opinion  have 
carefully  noted  it :  few  individuals  escape  its  action, 
even  of  those  in  whom  the  symptoms  of  Cholera 
have  not  been  realized. 

Almost  every  person  residing  in  countries  attack- 
ed by  the  epidemic  Cholera  complain  of  spontaneous 
lassitude,  general  uneasiness,  heaviness  of  the  head, 
frequent  vertigo,  and  prostration  carried  even  to 
syncope.  Hence  we  manifestly  perceive,  in  all  those 
individuals  who  are  placed  within  the  s  here  of  ac- 
tivity of  the  epidemic  influence,  the  unequivocal  in- 
dications of  a  change,  of  a  diminution  in  the  great 


47 

function  of  innervation,  that  is  to  say,  of  the  vivify- 
ing influence  of  the  nervous  system  upon  the  other 
systems,  upon  the  various  apparatuses,  and  upon  all 
the  organs  of  the  economy.  Such  is  the  capital,  es- 
sential, and  primitive  effect  of  the  epidemial  agent, 
since  it  is  exercised  upon  every  individual,  whether 
healthy  or  diseased,  strong  or  weak,  though  in  va- 
riable degrees  of  intensity.  This  effect,  at  the  same 
time  constant,  positive,  manifest,  predominates  over 
all  others. 

To  this  primary  consequence  of  the  diminution 
of  nervous  energy,  are  joined,  almost  simultaneously, 
constipation  or  a  slight  relax,  anorexia,  loss  of  ap- 
petite, flatulency,  a  gentle  diarrhoea,  in  short,  a  more 
or  less  considerable  disturbance  of  the  functions  of 
the  gastro-intestinal  mucous  membrane.  Thus,  on 
the  one  hand,  diminution  of  the  nervous  function  ; 
on  the  other,  evident  effects  of  this  depression  of 
the  nervous  energy  upon  the  mucous  membranes, 
which  are  thereby  imperfectly  supported,  vivified 
and  excited ;  these  are  the  two  primitive  effects 
produced  by  the  epidemic  influence.  Now,  if  we 
bear  in  mind  these  two  orders  of  phenomena,  the 
diminution  of  the  nervous  function  and  the  direct 
bearing  of  this  diminution  upon  the  mucous  system, 
we  will  manifestly  have  the  rudiments,  the  germ, 
and,  as  it  were,  the  diminutive  of  the  disease. 


48 

It  is  not  without  motive  that  we  would  be  desi- 
rous of  dwelling  longer  on  the  consideration  of  this 
important  order :  but  let  us  proceed. 

When  the  Cholera  is  developed,  and  when  the 
violence  of  its  assault  does  not  break  down  at  once 
the  bonds  of  the  living  organism,  the  symptoms  we 
have  mentioned  assume  greater  intensity.  Then 
commences  the  period  of  imminence  of  the  disease  ; 
a  period,  the  premonitory  symptoms  of  which  are 
oppression,  weakness  of  the  pulse,  discomposure  of 
the  countenance,  epigastral  anxiety,  all  which  symp- 
toms could  neither  be  so  rapidly  produced  nor  more 
naturally  explained  than  by  a  diminution  of  the  ner- 
vous energy,  the  effects  of  which  are  essentially  ex- 
pended upon  the  digestive  apparatus  and  circulatory 
system. 

After  the  example  of  nature,  in  the  course  of  this 
disease,  let  us  rapidly  run  over  the  disorders  and 

their  consequences. 

The  contractions  of  the  limbs  ;  cramps  of  the  ex- 
tremities ;  lypothemias  ;  faintings  ;  sinkings  ;  pale- 
ness ;  the  cold  and  shrivelled  condition  of  the  skin  ; 
the  blue  colour  of  the  fingers  and  nails  ;  the  hip- 
pocratic  countenance  occurring  in  an  instant  and 
without  any  apparent  cause  ;  the  altogether  peculiar 
and  frightfully  rapid  disappearance  of  the  vital 
powers,  which  are  broken  down,  extinct,  annihi- 
lated, if  they  can  be  said  to  be  at  all  in  action 
when  life  is  no   near  its    termination ;  but  which 


49 

on  the  contrary,  considered  in  existence,  are  feeble, 
though  excitable,  and  subsequently  become  vigo- 
rous, as  the  patient  often  passes  from  apparent  death 
to  perfect  health  as  rapidly  as  he  had  undergone 
the  contrary  change.  Do  not  these  symptoms 
manifestly  give  a  just  idea  of  the  disease  ?  In  fact, 
where  also  can  be  found,  but  in  the  reduction  of 
the  nervous  energy,  sufficient  cause  and  complete 
exposition  of  these  difficulties? 

It  is  because  the  gastro-intestinal  mucous  mem- 
ranes  are  no  longer  excited,  supported,  or  stimulated 
bv  the  influence  of  the  nervous  system,  that,  struck 
with  atony,  in  consequence  of  the  alteration  in  the 
whole  ganglionic  system,  they  no  longer  have  any 
regulated  action,  and  hence  the  depraved  and  aug- 
mented secretions  from  these  membranes. 

In  the  catarrhal  epidemic  affections,  hitherto 
described,  the  catarrhal  lesion  seldom  passes  be- 
yond the  pulmonary  and  gastro  intestinal  mem- 
branes. In  Cholera,  the  catarrhal  state  is  often 
propagated  to  all  the  mucous  membranes  in  the 
economy. 

Several  practitioners,  Doctor  Orton  among  others, 
has  seen  the  epidemic  Cholera  commence  with  di- 
arrhoea only,  and  even  consist  in  this  symptom  alone ; 
the  disease  otherwise  preserving  all  its  rapidity  and 
all  its  dangers. 


50 

It  is  generally  in  the  form  of  severe  epidemic 
that  catarrhal  diseases  make  their  appearance. 

The  humidity  of  the  conjunctiva,  the  softness  and 
flaccidity  of  the  tongue,  which,  in  addition,  is  com- 
monly cold,  slimy,  and  white,  the  pathological  state 
of  the  mucous  membranes,  the  marked  alteration 
in  the  mucous  secretion  of  the  stomach  and  bow- 
els, are  incontestable  indications  of  this  particular 
catarrhal  state. 

Life,  purely  virtual,  scarcely  inherent,  as  if  it  could 
no  longer  suffice  for  the  whole  economy  and  defend 
itself  upon  all  points,  abandons  the  circumference 
and  recedes  towards  the  centre ;  it  shrinks  back 
upon  itself,  and  becomes  concentrated  at  the  interi- 
or. Hence  we  see  that  there  is  no  more  evidence  of 
vital  reaction  in  the  circulatory  apparatus  than  else- 
where ;  the  pulse  is  scarcely  perceptible  ;  respira- 
tion is  inaudible  ;  leeches  can  no  longer  extract  even 
one  drop  of  blood  ;  and  the  largest  apertures  made 
in  the  veins,  with  the  view  of  bleeding,  scarcely 
permit  us  to  express  the  smallest  quantity  of  this 
fluid,  which  besides  is  thick,  black,  and  viscid. 

The  act  of  formation,  the  pathogeny  of  Cholera, 
as  well  as  the  Cholera  itself,  enlighten  our  judg- 
ment then  in  the  determination  of  the  seat  and  nature 
of  this  disease. 

Vomitings ; 

Dejections ; 


51 

Matters  vomited,  resembling  a  strong  decoction 
of  rice  ; 

Matters  dejected,  aqueous,  flocculated,  whitish, 
abounding  in  mucosities  ; 

The  skin,  pale,  cold,  damp,  and  wrinkled,  especi- 
ally on  the  hands  and  feet,  as  if  these  parts  had 
been  covered  by  a  cataplasm ; 

The  tongue,  white,  soft,  moist  and  cold,  notwith- 
standing the  patient  is  devoured  with  an  unquench- 
able thirst ; 

The  mucous  membrane,  often  softened  and  thick- 
ened, and  still  more  frequently  covered  with  a  vis- 
cid, whitish,  opake,  creamy  substance,  which,  in 
certain  cases,  is  so  abundant  that  it  obstructs  the 
whole  of  the  intestinal  canal ; 

The  genito-urinary  mucous  membrane  and  the 
pulmonary  mucous  membrane  in  a  similar  state  ; 
which  is  never  the  case  in  ordinary  acute  catarrhal 
diseases,  where  the  alteration  is  limited  to  the  gas- 
trointestinal and  pulmonary  mucous  membranes : 

Such  are  the  symptoms  which  incontestably  prove 
the  catarrhal  state. 

Let  us  now  present  the  characters  of  the  nervous 
state,  which  are  not  less  decisive  : 

1.  The  epigastral  anxiety  ; 

2.  The  spasms ; 

3.  The  contractions  of  the  limbs  ; 
4L  The  cramps  of  the  extremities ; 


52 

5.  Lypothemiae ; 

6.  Syncope  ; 

7.  The  cold  breath  of  the  patient ; 

8.  The  weakness  and,  as  it  were,  disappearance 

of  the  pulse ; 

9.  The  insensibility  of  the  respiration  ;  and 
10.  The  Hippocratic  countenance. 

Let  us  now  recapitulate  this  doctrine. 

The  Cholera,  in  its  diverse  periods  of  duration, 
in  its  variable  degrees  of  intensity,  is  a  special,  com- 
plicated and  complex  disease,  characterized  by  a 
great  diminution  of  nervous  energy,  combined  with 
a  particular  catarrhal  state  of  the  gastro-intestinal 
mucous  membrane. 

Either  of  these  two  pathological  conditions  is 
susceptible  of  predominating  to  such  an  extent  as 
to  demand  more  particularly  clinical  attention,  ac- 
cording as  they  are  dependent  upon  individual  pe- 
culiarities of  constitution,  the  different  stages  of  the 
disease,  &c. 

The  predominance  of  the  catarrhal  over  the  ner- 
vous state,  and  reciprocally,  varies  especially  with 
the  rapid,  fugacious,  stages  of  the  disease.  In  the 
first  stage,  the  symptoms  of  the  nervous  affection 
are  those  which  generally  predominate  ;  in  the  se- 
cond, the  gastro-intestinal  catarrhal  affection  is  most 
prominent.  Almost  always,  however,  the  two  stages 
unite,  combine,  and  become  confounded,  and  with 


53 

them  are  also  mingled  and  blended  the  phoenome- 
nal  characters  of  the  two  pathological  states. 
Such  is  the  disease  when  exalted  to  its  highest  de- 
gree  of  intensity.  It  requires  all  the  attention,  all 
the  sagacity  of  the  enlightened  observer,  in  order  to 
lav  hold  of  these  various  combinations.  It  is  to  the 
predominance  of  the  nervous  affection,  towards  the 
advanced  stages  of  the  disease,  that  we  must  attri- 
bute those  frequent  typhoid  transmutations  which 
we  observe  at  the  termination  of  Cholera.  Still  is  it 
very  probable,  from  a  great  number  of  facts,  that 
even  the  phoenomena  of  the  catarrhal  affection  are 
a  primary  consequence  of  the  diminution  of  the 
nervous  energy. 

Having  thus  investigated  the  disease  in  its  period 
of  formation,  or  in  its  course  from  health  to  disease, 
let  us  now  examine  the  inverse  period,  that  is  the 
the  transition  from  disease  to  health,  or  the  cure, 
and  see  what  it  will  teach  us. 

One  of  the  first  indications  of  cure,  in  the  epi- 
demic Cholera,  is  the  presence  of  bile  in  the  evacua- 
tions by  stool  and  vomiting. 

A  still  more  favourable  sign,  is  the  restoration  of 
heat  to  the  external  surface  of  the  body,  and, 
especially,  the  cessation  of  the  stupor  and  spasms  in 
conjunction  with  these  circumstances.  If  the  stu- 
por and  spasms  increase  at  the  moment  the  cessa- 
tion of  vomiting  and  purging  supervenes,  mistrust 
the  fate  of  your  patient. 

6* 


54 

The  appearance  of  perspiration  is  almost  always 
a  favourable  indication. 

The  respiration  becoming  free  and  easy,  the  beat- 
ing of  the  pulse  returning  with  regularity  in  the 
radial  artery,  the  free  secretion  of  urine  ;  such 
are  the  changes  which  generally  precede  the  cure  ; 
and  it  is  here  especially  we  would  note  that  the 
return  to  health,  after  an  apparent  death,  is  neither 
less  remarkable  nor  less  rapid,  than  has  been,  in  the 
inverse  direction,  the  transition  from  the  state  of 
most  perfect  health  to  that  of  the  most  alarming- 
disease. 

In  fine,  wherever  the  disease  has  been  observed, 
it  has  been  constantly  noticed  that  we  have  reason 
to  augur  well  of  those  patients  in  whom  there  have 
appeared  certain  signs  of  the  definitive  cessation  of 
the  concentration  of  the  forces  at  the  centre,  and  in 
whom,  on  the  other  hand,  were  manifested  satisfac- 
tory evidences  of  the  proper  radiation  of  the  vital 
powers  to  the  circumference. 

Thus  then,  the  manner  in  which  the  morbid  phe- 
nomena are  developed  and  connected,  as  well  as 
the  course  in  which  they  are  lessened  and  dissipated, 
equally  tend  to  prove  that  the  disease  consists  in 
the  diminution  or  suspension  of  the  nervous  func- 
tion, combined  with  a  catarrhal  lesion  of  the  gastro- 
intestinal mucous  membranes. 


55 

Let  us  exhaust,  if  possible,  this  order  of  consider- 
ations, and  see  whether  the  treatment  which  the 
epidemic  Cholera  has  undergone,  can  furnish  us 
with  useful  deductions.  The  etiological  inductions 
drawn  from  therapeutic  measures  are  scarcely  less 
useful,  or  less  certain  than  the  curative  indications 
which  we  deduce  from  them.  It  is  a  just  observa- 
tion, a  juvantibus  et  Icedentibus  Jit  indication  and 
with  equal  propriety  we  might  say,  a  juvantibus  et 
Icedentibus  Jit  dignotio. 

One  means  of  cure  pretty  generally  adopted 
in  epidemic  Cholera,  is  blood-letting  :  but  it  should 
be  remarked  that,  upon  all  points  and  in  the  eyes 
of  all  individuals,  the  bleeding  recommended,  here 
especially,  from  the  commencement  of  the  disease, 
has  been  clearly  and  specially  denoted  by  the  title 
revulsive,  and  is  employed  as  a  means  of  re- 
animating, or  recalling  the  excentric  circulation. 

Furthermore,  bleeding,  which  is  condemned  by 
a  considerable  number  of  skilful  practitioners,  is 
adopted  by  none,  unless  in  cases  where  the  patient 
is  young  and  of  a  robust  constitution. 

M.  Noel,  in  the  midst  of  a  pretty  extensive  epi- 
demic, performed  wonders  by  means  of  liquid  am- 
monia, given  several  times  a  day  in  an  aromatic  infu- 
sion. M.  Deville  quickly  dissipated  the  disturbances 
by  the  aid  of  a  large  dose  of  ether,  administered  im- 
mediately on  the  accession  of  the  disease.     Every 


56 

where  opium  has  been  associated  with  diftusibles, 
with  musk,  with  camphor,  ether,  or  essence  of  mint ; 
every  where  have  been  prescribed  with  success 
tonics,  bitters  and  aromatics.  The  Russians  have 
particularly  extolled  vapour  baths,  warm  aromatic 
applications  to  the  skin,  stimulating  frictions,  &c. 

Vesicatories  of  every  kind  and  in  every  degree 
sinapisms,  and  external  cauterizations,  are  so  many 
means  which  have  in  their  turn  been  resorted  to. 

Quite  recently  Doctor  Leo  has  endeavoured  to 
prove,  from  a  great  number  of  convincing  facts,  that 
the  method  most  constantly  efficacious  against  the 
cholera,  consists  in  the  employment  of  sufficient  doses 
of  the  sub-nitrate  of  Bismuth,  one  of  the  most  active 
antispasmodics  with  which  we  are  acquainted. 

Doubtless  we  have  presented  enough  of  these 
powerful  indices  to  demonstrate  that  the  therapeu- 
tic means  concur  with  the  analytic  symptomatol- 
ogy, in  conducting  to  similar  conclusions. 

Having  stated  what  the  disease  is,  let  us  now  pro- 
proceed,  by  way  of  exclusion,  to  say  what  it  is  not. 
Without  contradiction,  the  epidemic  Cholera  is  not 
an  inflammatory  disease  ;  still  less  is  it  a  particular 
inflammation  of  a  determinate  organ.  If  the  chol- 
era was  a  gastro-interitis,  or  a  hepatitis,  the  light  of 
pathological  anatomy  would  certainly  have  revealed 
it  to  us  ;  and  even  should  all  the  circumstances  of 
the  disease  not  combine  to  prove  that  the  epidemic 


57 

cholera  is  not  essentially  inflammatory,  would  not 
the  total  absence  of  every  vital  re-action,  the  fre- 
quent want  of  every  febrile  movement,  in  the  first 
stages  of  the  disease,  be  of  themselves  sufficient  to 
exclude  such  an  opinion  ?  Let  us  also  add  that 
there  never  has  been  observed,  in  the  autopsic  ex- 
aminations of  those  who  have  died  of  epidemic 
cholera,  any  of  those  frequent  terminations,  common 
degenerations,  or  ordinary  transformations,  which 
result  from  inflammatory  diseases. 

Neither  is  the  epidemic  cholera  a  typhus.  The 
patients  retain  to  the  last  moment  the  integrity  of 
their  intellectual  faculties :  conscience,  judgment, 
reason,  presence  of  mind,  all  remain  entire  ;  and 
fever  scarcely  presents  itself  in  the  simple  and  so 
frequent  cases  of  epidemic  cholera.  .  There  has  not 
been  observed  in  cholera  those  numerous  symptoms 
of  vital  re-action  which  are  inseparable  from  typhus, 
such  as  heat  of  skin,  redness  and  animation  of  coun- 
tenance, cough,  &c.  and  never  has  it  been  at- 
tended with  exanthematous  eruptions,  sudamina,  or 
petechias. 

Finally,  as  has  been,  very  judiciously  noted  by 
MAI.  Briere  de  Boismont  and  Legallois,  the  typhus 
is  most  frequently  accompanied  with  a  great  sono- 
riety  of  the  abdomen,  whilst,  in  cholera,  this  part 
of  the  body  is  particularly  remarkable  for  its  ob- 
tuseness, 


58 

Neither  does  medical  analysis  permit  the  reduc- 
tion or  conversion  of  the  epidemic  cholera  into  a 
simple  affection,  a  mere  catarrhal  alteration:  this 
would  be  too  great  a  miscontruction  of  the  remark 
made  upon  one  of  the  characters  of  the  mucous 
system  in  general  and  of  the  gastro-intestinal  mu- 
cous membrane  in  particular.  The  ensemble  of 
the  symptoms  connected  with  epidemic  cholera, 
their  developement,  succession  and  rapidity,  as 
well  as  the  formidable  terminations  of  the  disease, 
decidedly  repel  this  assertion. 

Finally,  what  judgment  can  we  pass  upon  the  opi- 
nion promulgated  at  Moscow  in  consequence  of  the 
chemical  experiments  of  M.  Hermann,  by  which  the 
epidemic  cholera  is  made  to  depend  upon  the  devia- 
tion of  a  particular  acid,  which  this  chemist  pretends 
to  have  discovered  in  the  blood  in  the  normal  state, 
in  that  of  persons  in  good  health ;  an  acid  which  M. 
Hermann  no  longer  meets  with  in  the  blood  of 
choleric  patients,  but  which  on  the  contrary  is  de- 
tected in  great  abundance  in  the  matters  discharged 
by  vomiting  and  by  stool. 

Now,  in  the  first  place,  the  symptoms  of  the  dis- 
ease do  not  in  the  least  degree  coincide  with  this 
presumed  cause,  neither  does  the  treatment,  not- 
withstanding, in  a  small  number  of  cases,  the  cal- 
cined magnesia  has  been  given  with  an  appear- 
ance of  success. 


59 

But  let  us  attack  this  opinion  on  its  own  ground 
since  we  can  there  oppose  it  with  its  own  weapons. 
Numerous  and  appropriate  experiments,  repeatedly 
made  by  Annesley,  have  demonstrated  most  con- 
clusively that  the  matters  of  the  stools  and  vomiting 
contain  no  free  acid. 

It  is  thus  that  Annesley  has  satisfactorily  refuted 
the  opinion  of  Dr.  Ainslie,  who,  in  India,  had  also 
attempted  to  attribute  the  epidemic  cholera  to  the 
existence  of  a  particular  acid,  contained,  according 
to  him,  in  the  matter  of  the  secretions. 

And  as  to  ihe  presence  of  a  free  acid  in  the  blood 
in  the  normal  state,  this  assertion  is  found  contra- 
dicted by  every  satisfactory  experiment  hitherto 
presented. 

The  property  which  the  blood  possesses  of  turn- 
ing the  syrup  of  violets  green  has  been  remarked 
by  chemists  of  the  greatest  antiquity  ;  and  the  ex- 
periments of  Rouelle,  the  younger,  undertaken  with 
the  view  of  determining  the  nature  of  the  alkaline  salt 
mentioned  by  Haller  and  De  Haen,  have  long  since 
settled  beyond  a  doubt  the  existence  of  the  sub-car- 
bonate of  soda  in  the  blood. 

Bucquet,  Baume,  Parmentier  and  Deyeux  have 
since  confirmed  the  results  of  the  experiments  of 
Rouelle.  Not  only  have  they  proved  the  presence 
of  an  alkaline  salt  in  the  blood,  but  they  have  also 


60 

proved  the  entire  neutrality  of  the  product  ob- 
tained by  its  distillation  in  the  balneum  maris. 

Dr.  Marcet,  MM.  Bestock,  Berzelius,  Brande, 
Dumas,  Prevost  and  John  of  Berlin,  in  their  publi- 
cations on  the  blood,  all  agree  in  conceding  to  this 
liquid  the  alkaline  character. 

Finally,  if  there  was  any  absolute  necessity  for  it, 
we  might  cite,  in  support  of  this  opinion,  the  results 
of  the  recent  experiments  which  Dr.  Dennis  of  Com- 
mercy  has  detailed  in  his  important  work  on  the 
human  blood,  and  we  might  also  cite  those  which 
make  the  subject  of  a  memoir  yet  unpublished,  to 
which  the  Academy  has  just  granted  a  golden  medal. 

M.  John,  in  his  tables  of  the  chemical  analysis 
of  the  animal  kingdom,  translated  by  M.  Robinet, 
announces,'  it  is  true,  that  Prout  has  found  free 
acetic  acid  in  the  blood  ;  but  in  consulting  the 
original  memoir,  volume  xxxvi,  page  258  of  the 
Annates  de  Chimie,  we  soon  ascertained  that  the 
German  chemist  had  fallen  into  an  error.  Prout 
does  not  certify  the  presence  of  free  acetic  acid 
in  the  blood,  but  the  existence  of  Benzoic  acid 
only,  which  M.  John  himself  affirms  to  be  combined 
with  the  soda. 

Doctor  Albert,  sent  by  the  King  of  Prussia  to 
Moscow  for  the  purpose  of  studying  the  cholera,  en- 
deavours to  prove  that  the  disease  consists  in  a 
paralytic  affection  of  the  heart.     In  support  of  this 


61 

opinion  he  cites  the  extreme  anguish,  the  oppression, 
the  suffocation  with  which  the  patients  are  seized  ; 
and  if  the  circulation,  says  he,  at  the  circumference 
is  imperfectly  carried  on,  it  is  because  the  heart 
wants  energy  to  propel  the  blood  from  the  centre 
to  the  periphery. 

This  method  of  investigating  the  nature  of  cholera 
slightly  approximates  to  the  opinion  promulgated 
by  us.  However,  the  opinion  of  Dr.  Albert  is  by 
far  too  exclusive,  much  too  positive  ;  by  us  it  par- 
ticularly appears  incomplete,  inasmuch  as  M.  Albert 
has  apprehended  but  one  of  the  fractions  of  the 
disease.  In  the  opinion  of  the  Prussian  physician 
the  cholera  should  be  classed  with  the  angina  para- 
lytodea  of  certain  observers,  and  surely  the  phe- 
nomenal characteristics  of  the  two  diseases  are  far 
from  bearing  a  resemblance. 

In  such  an  opinion  how  can  we  account  for  the 
principal  symptoms  of  cholera,  for  the  vomitings, 
the  alvine  evacuations,  the  epigastral  pains,  the 
cramps  of  the  extremities,  the  mucous  contents  of 
the  intestines,  &c.  Neither  analogy,  nor  the  simili- 
tude of  cholera  and  angina  paralytodea,  could 
support  it. 

Several  meritorious  authors  have  sought  to  estab- 
lish that  the  primary  cause  of  epidemic  cholera 
resides  in  a  change  of  relation  between  the  atmos- 
pheric electricity  and  the  animal  electricity.     This 

7 


62 

doctrine  doubtless  is  not  entirely  devoid  of  facts  for 
its  support.  Without  doubt  also  it  is  not  unreason- 
able, neither  is  it  novel  to  suppose  that,  in  the  do- 
main of  diseases,  in  general,  the  electricity  of  the 
atmosphere  performs  a  certain  part.  But  the  phys- 
ical observations,  besides  being  difficult,  dangerous 
even  to  attempt,  and  also  the  clinical  comparative 
observations,  being  not  less  easy  to  collect,  are  want- 
ing even  for  the  mere  discussion  of  this  opinion. 

r 

CONCLUSION. 

The  critical  and  exact  analysis  of  the  symptoms 
and  necroscopic  characters  of  cholera  give  this 
result :  that  the  disease,  complex  in  its  nature,  con- 
sists in  a  general  diminution  of  nervous  energy 
combined  with  a  particular  catarrhal  affection  of 
the  gastro-intestinal  mucous  membranes. 


PART  FOURTH. 


PROGNOSIS. 

The  Cholera-Morbus,  abandoned  to  the  resources 
of  nature  alone,  is  almost  always  mortal.  On  the 
contrary,  by  means  of  the  assistance  of  art,  if 
dispensed  in  time  and  appropriately,  this  cruel 
disease  is  often  happily  subdued.  This  remark  had 
already  been  made  by  Hoffman  ;  and  it  is  thus  that 
Frank  expresses  himself  upon  this  point :  Funestus 
est  plerumque  Ckolerce,  sibi  ipsi  relictoz,  exitus  :  sub 
artis  vero  prozsidio  sat  cito  concesso,  plerique  ex 
ilia,  quod  tanta  in  alio  morbo  symptomata  vix  sperari 
permitterent,  sanantur. 

Similar  results  of  clinical  observation  have  been 
noticed  in  every  place  where  the  epidemic  has 
reigned. 

Two  principal  considerations  arise,  as  a  general 
prognostic,  from  the  study  of  this  cruel  malady. 

On  the  one  hand,  the  physician  should  not  permit 
himself  to  be  disheartened  by  the  most  desperate 
symptoms — the  absolute  insensibility  of  the  pulse  ; 
the  coldness  of  the  tongue  ;  the  icy  coldness  of  the 
precordial  region.     A  great  number  of  particular 


64 

cases  prove  that  patients,  even  in  this  state,  prop- 
erly taken  care  of,   have  been  restored  to  health. 

On  the  other  hand,  the  physician  in  attendance 
should  never  place  too  much  confidence  in  the  fa- 
vourable symptoms  ;  such  security  would  be  fatal. 
The  most  encouraging  state,  in  appearance,  if  the 
treatment  is  suspended  and  the  patient  left  to  him- 
self, does  not  delay  to  become  desperate  ;  such  a 
condition  leads  to  a  relapse  or  to  death.  It  is  under 
the  influence  of  similar  conditions  that  typhoid 
mutations  occur. 

The  vomiting  is  incontestably  one  of  the  most 
serious  symptoms  of  this  disease  ;  it  generally  per- 
sists for  a  long  time  after  the  dejections  and  spasms 
have  ceased,  and  even  when  the  disease  assumes  a 
favourable  termination,  the  vomiting,  by  its  obsti- 
nacy, fatigues  and  exhausts  the  patient,  retards  the 
cure  and  protracts  the  convalesence. 

In  general  the  appearance  of  bile  in  the  evacua- 
tions is  a  good  omen :  it  is  seldom  that  the  cure 
takes  place  without  the  existence  of  this  sign. 

As  much  may  be  said  of  the  free  course  of  the 
urine ;  of  the  manifestation  of  halituous  sweats  ; 
of  the  diminution  of  the  stupor  ;  of  the  restoration 
of  the  forces ;  of  the  cessation  of  the  cramps. 

It  is  especially  from  the  intensity  of  the  symp- 
toms which  arise  from  the  derangements  of  the 
nervous  function,  that  we  must  draw  our  calcula- 


65 

tions  of  the  dangers  of  the  disease.  The  symptoms 
of  the  catarrhal  state  possess  but  a  secondary  im- 
portance. It  has  often  been  observed,  after  the 
vomiting  and  stools  have  ceased,  that  the  danger 
has  gone  on  constantly  increasing :  but  then  the 
cramps,  the  restlessness  of  the  patient,  the  coldness 
of  the  chest  and  of  the  epigastric  centre,  the  insen- 
sibility of  the  pulse,  went  on  increasing  also. 

The  rising  and  frequency  of  the  pulse  are  in 
general  good  signs  :  these  are  sometimes  observed 
as  the  cure  approaches. 

In  a  pretty  great  number  of  cases,  the  pulse 
resumes  its  natural  rythm ;  sensation  and  heat 
spring  up  in  the  extremities ;  the  vomiting  and 
diarrhoea  cease  ;  yet,  however,  if  by  the  assistance 
of  art  we  do  not  continue  every  proper  effort  to 
support  and  revive  the  forces,  the  disease  makes 
progress,  and  the  patient  dies. 

In  fine,  the  data  upon  which  the  practitioner  may 
legitimately  be  allowed  to  predict  a  favourable 
issue  of  the  disease,  are  :  the  manifestation  of  fever; 
fulness  of  the  pulse  ;  restoration  of  heat  to  the  ex- 
tremities ;  the  diminution  of  the  avidity  for  cold 
drinks  ;  the  gradual  disappearance  of  the  epigastral 
anxiety,  and  of  the  burning  heat  at  the  umbilical 
region  ;  the  cessation  of  the  spasms,  vomiting  and 
diarrhoea  ;  the  free  flow  of  bile  and  urine ;  the 
improvement  of  the  physiognomy  ;  the  return  to- 

7* 


66 

wards  the  normal  state  of  the  aspect  and  functions 
of  the  skin ;  the  respiration  easy  and  regular ;  the 
normal  heat  communicated  to  the  air  expired  by 
the  patient  ;  the  vermiliion  colour  of  the  lips, 
tongue,  and  mouth  ;  animation  of  the  eyes. 

The  chances  of  safety  increase  or  diminish  ac- 
cording to  the  physical  complexion  or  moral  situa- 
tion of  the  patient,  and  according  to  the  conditions 
of  the  public  and  private  hygiene,  under  the  influ- 
ence of  which  Cholera  patients  are  found  placed. 

In  India,  death  occurred  more  promptly  among 
the  natives  enfeebled  by  excess  and  misery,  than 
among  Europeans  who  lived  more  regular  and  bet- 
ter lives. 

There  are  many  more  chances  of  safety  for  in- 
dividuals of  a  strong  constitution,  and  for  those  who 
have  not  been  debilitated  by  excesses,  by  distress 
and  anxiety  of  mind,  or  by  fear. 

Patients  accumulated  in  hospitals  or  in  prisons, 
placed  in  encumbered,  narrow,  low,  moist,  and  im- 
pure wards ;  who  groan  without  attention,  without 
assistance,  in  the  desolation  and  want  attendant  on 
poverty  ;  these  are  cured  with  great  difficulty. 

When  the  disease  is  about  to  be  cured,  we  see 
the  symptoms,  even  the  most  characteristic  of  dan- 
ger and  the  most  violent,  momentarily  suspended, 
and  presenting  more  or  less  decided  intermissions. 

The  chances  of  success  or  reverse,  of  safety  or 


67 

destruction,  vary  according  to  the  periods  of  the 
epidemic.  The  disease  is  particularly  more  severe 
and  more  frequently  mortal  at  the  commencement 
of  the  general  malady.  The  reverses  greatly 
diminish,  when  the  period  of  epidemical  augment 
is  found  exhausted.  At  the  close  of  the  epidemic, 
nature  is  almost  sufficient  to  perform  the  cure. 

The  disease  often  leaves  behind  it  tardy  and 
painful  convalescences,  from  which  patients  cannot 
extricate  th .mselves. 

Various  statistical  calculations  havo  been  pub- 
lished with  the  view  of  establishing  the  chances  of 
invasion  of  the  disease  and  of  mortality  in  the  midst 
of  the  diverse  populations  invaded  by  cholera  ;  but 
wherever  these  calculations  have  been  attempted, 
the  principal  data  of  the  problem  present  so  little 
of  fixity  and  exactitude,  that  with  an  appearance  of 
mathematical  accuracy,  these  calculations,  for  this 
reason,  can  only  record  in  a  manner  more  deplora- 
ble, the  errors  which  are  the  inevitable  consequence 
of  them. 

The  evacuations  upwards  and  downwards  seem 
to  have  been  more  frequent,  more  abundant,  and 
more  obstinate  in  Asia  than  in  Europe  ;  but  the 
physical  characters  of  these  evacuations  have  been 
every  where  the  same. 

The  return  to  health  after  the  first  period  of  the 
disease,  without  the  patient's  passing  into  the  febrile 


68 

state,  has  been  much  more  common  in  India ;  and 
there  also  the  typhoid  mutations  or  terminations 
have  been  much  less  frequent. 

The  number  of  patients  among  physicians  and 
attendants  employed  in  hospitals,  compared  with 
the  number  of  patients  among  the  rest  of  the  popu- 
lation, has  been  more  considerable  on  the  Euro- 
pean continent  than  in  Asia  ;  it  is  certain,  however, 
that  in  general,  in  hospitals  conveniently  situated, 
sufficiently  aired  and  kept  properly  cleansed,  there 
have  been  but  few  victims,  even  among  the  phy- 
sicians and  nurses. 

The  attack  when  it  is  not  fatal,  presents  three 
different  issues : 

Immediate  convalescence,  followed  only  by  great 
debility ; 

Abundant  evacuations  of  bile  voided  during  sev- 
eral days,  sometimes  mingled  with  blood,  and  at- 
tended with  particular  intestinal  pains,  and  especi- 
ally with  pains  in  the  rectum  ; 

A  febrile  state,  the  description  of  which  is  faith- 
fully traced  in  the  report  from  Bengal.  The  follow- 
ing are  its  principal  features  : 

The  fever  which  constituted  the  last  period  of 
the  disease,  presented  great  analogy  with  the  bilious 
fevers  usually  spread  abroad  in  these  climates.  We 
could  observe  the  following  symptoms :  heat  and 
dryness  of  the   skin,    tongue  very   much  loaded, 


69 

mouth  dry,  epigastral  anxiety,  agitation,  insomnium, 
pulse  very  variable,  sometimes  stupor,  delirium  and 
other  symptoms  of  cerebral  affection.      * 

In  general,  when  the  disease  was  disposed  to 
terminate  fatally  during  this  period,  the  tongue, 
from  the  colour  of  cream,  became  dry,  brown,  and 
even  black,  it  also  became  more  loaded ;  the  teeth 
and  lips  covered  with  a  fuliginous  sordes  ;  the  state 
of  the  skin  varied  considerably,  shiverings  and 
flashings  of  heat  succeeded  alternately ;  the  pulse 
was  accelerated,  feeble,  fluttering  ;  plaintive  moans, 
hiccup,  agitation  and  oppression  supervened ;  and 
the  patient  soon  lost  all  consciousness  from  the  de- 
bilitating effects  of  this  nervous  fever,  and  also 
from  frequent  alvine  evacuations,  which  were  al- 
ways of  a  dark  colour. 


PART  FIFTH. 


TREATMENT. 

What  we  have  learnt  from  the  physicians  who 
have  practised  in  India  in  relation  to  the  treatment 
of  Cholera,  is  characterized  by  a  want  of  precision, 
indecision,  and  uncertainty.  Here,  it  is  bleeding 
which  reigns  over  all  the  other  therapeutic  means ; 
there,  it  is  opium  combined  with  aromatics,  with 
spirits,  and  with  tonics.  In  the  eyes  of  the  greatest 
number,  calomel  given  in  most  exhorbitant  doses  is 
the  real  sheet-anchor.  Some  have  boasted  beyond 
measure  of  alkalis  ;  others  have  extolled  acids.  And 
unfortunately  it  is  upon  preconceived  notions,  upon 
the  supposed  nature  of  the  disease,  that  these  vari- 
ous therapeutic  means,  always  too  generally  and  too 
exclusively  employed,  entirely  depend. 

In  meditating  attentively  upon  particular  cases, 
in  keeping  an  exact  account  of  general  assertions, 
we  see  that  patients  have  been  treated  by  bleeding, 
yet  they  sink ;  that  calomel  has  been  administered 
to  them,  yet  they  die ;  that  opium  is  given  to 
them,  yet  they  equally  perish  ;  that  these  differ- 
ent means  are  even  combined,  yet  they  do  not  effect 
their  cure.     These  are  serious  and  melancholy  re- 


71 

flections,  which   hereafter,   perhaps,  may  be  pro- 
ductive of  benefits. 

Bloodletting  is,  without  contradiction,  one  of  the 
means  which  has  been  most  generally  advised,  one 
of  those  upon  the  efficacy  of  which  the  advice  and 
opinions  of  the  physicians  of  India  most  frequently 
agree.  To  note  it  at  the  head  of  all  the  others,  and 
to  discuss  it  in  the  first  place,  is  a  duty ;  for  this 
reason  especially,  that  it  is  almost  exclusively  from 
the  period  of  imminence,  from  the  beginning  of  the 
disease,  that  it  is  indicated.  Still  later,  in  the  eyes 
of  some  respectable  physicians,  bleeding  is  useless 
and  injurious,  difficult  or  impossible.  It  is  not  rare, 
however,  to  find  physicians  who  proclaim  the  good 
effects  of  bleeding  in  almost  every  stage  of  the  dis- 
ease. These  physicians  facilitate  the  escape  of  the 
blood  from  the  vein,  when  it  is  expressed  from  it 
with  difficulty,  either  by  plunging  the  arm  in  very 
warm  water,  or  by  applying  dry  or  aromatic  fric- 
tions to  this  superior  extremity,  or  still  further  by 
dipping  the  arm  in  a  demi-bath,  consisting  of  a  very 
strong  infusion  of  mustard. 

But  it  is  particularly  at  the  onset  of  the  disease 
that  blerding  is  useful ;  it  is  to  this  epoch  that  it 
has  been  specially  assigned  by  Annesley :  and  it  is 
hence  that  Mil  wood  has  observed,  out  of  eighty- 
eight  patients  bled  in  season,  two  only  died,  whilst 
he  had  lost  eight  out  of  twelve  of  those  who  had  not 


72 

been  bled.  The  author  has  not  stated  at  what  epoch 
of  the  epidemic,  nor  upon  what  order  of  patients,  he 
has  noted  these  facts. 

At  this  period  of  the  disease,  the  sanguineous  emis- 
sion tends  to  re-establish  the  equilibrium  of  the  cir- 
culation, which,  without  it,  abandons  the  periphery 
in  order  to  concentrate  itself  about  the  heart  and 
large  vessels  ;  it  acts  after  the  manner  of  diffusible 
antispasmodics.  When  the  pulse  rises  after  blood- 
letting, there  are  great  chances  of  cure,  says  Dr. 
Foy,  in  his  letter  to  our  fellow-member  M.  Bally. 

Still  later,  bleeding  has  been  found  mortal  by  a 
great  number  of  physicians.  M.  Annesley,  how- 
ever, cites  examples  of  bloodletting  performed  at  a 
very  advanced  stage  of  the  disease,  the  result  of 
which  has  also  been  to  recall  the  circulation  to  the 
circumference  :  in  these  examples,  the  blood  was  at 
first  thick,  and  merely  escaped  from  the  vein  gut- 
tatim,  but  towards  the  last  it  flowed  more  easily, 
became  more  fluid,  and  assumed  a  vermillion  colour. 
This,  axlds  this  physician,  was  the  result  to  be  de- 
sired ;  no  matter  whether  it  happened  after  the 
subtraction  of  ten,  twenty,  or  thirty  ounces  of  blood, 
even  if  it  occurred  as  soon  as  a  single  ounce  was 
obtained,  we  might  hope  for  the  recovery  of  the 
patient. 

Let  us  observe,  however,  that  a  great  number  of 
patients  have  sunk  after  the  abstraction  of  eighteen 


73 

or  twenty  ounces  of  blood  :  and,  on  the  other  hand 
many  cases  of  cure  have  been  accomplished  under 
circumstances  in  which  bleeding  has  not  been  re- 
sorted to. 

With  respect  to  bleeding  performed  when  the 
disease  is  threatened,  (periode  de  Vimminence])  two 
important  remarks  present  themselves. 

Bloodletting,  thus  considered,  is  almost  always 
advised  in  young  individuals  of  a  robust  constitution, 
and  who  are  placed  in  the  midst  of  circumstances  most 
favourable  for  the  cure  :  it  is  performed  early,  and, 
very  probably,  upon  individuals  who,  even  without 
this  means,  would  have  been  but  slightly  indisposed. 

In  the  second  place,  it  appears  certain  that,  in 
many  cases  this  means  has  been,  unfortunately, 
abused,  and  that  wTith  the  view  of  adopting  bleeding 
at  the  most  favourable  period,  and  of  making  it  a 
preservative  against  the  disease,  individuals  have 
been  bled  who,  debilitated  by  this  loss  of  blood, 
have  thereby  been  rendered  only  the  more  accessi- 
ble to  the  epidemical  influence,  and  more  cruelly 
treated  by  the  disease.  Perhaps  if  bloodletting  had 
not  been  resorted  to,  they  would  not  have  been  the 
subjects  ot  the  disease. 

Leeches  have  but  rarely  been  employed  in 
Cholera :  in  the  commencement,  however,  they 
have  been  applied  for  the  purpose  of  diminishing 
the  intensity  of  the  cardialgia.     We  know,  more- 

8 


74 

over,  that  leeches  often  remain  adherent  without 
any  secondary  effect,  and  that  frequently  also  they 
can  extract  but  a  few  drops  of  blood. 

Calomel.  Scarcely  was  there  a  single  physician, 
during  the  continuance  of  the  epidemic  on  the  con- 
tinent of  Asia,  who  did  not  loudly  proclaim  the  valu- 
able properties  of  calomel ;  yet  we  know  what  the 
mortality  has  been  in  this  part  of  the  globe !  Scarcely 
in  the  numerous  cases  of  Cholera  which  we  have 
had  occasion  to  read,  can  we  cite  any  patients  who 
have  not  taken  calomel ;  yet,  has  the  issue  of  the 
disease  been  the  less  fatal  ?  It  is  true  that  the  phy- 
sicians and  surgeons  in  India  are  of  the  English  school; 
and  we  are  not  ignorant  that  in  that  country,  all 
obscure,  difficult,  and  dangerous  cases,  as  well  as 
those  in  which  the  indication  is  simple,  regular,  and 
manifest,  calomel,  sometimes  in  one  dose,  sometimes 
in  another,  always  finds  its  place,  with  the  title  of 
specific,  antispasmodic,  antiphlogistic,  or  purgative. 

Annesley  administers  calomel  in  scruple  doses  sev- 
eral times  a  day,  with  a  view  of  relieving  the  intestinal 
mucous  membrane  of  the  creamy  substance  which 
chokes  up  and  obstructs  the  intestines.  Of  all 
purgatives,  calomel,  according  to  this  author,  is  the 
only  one  which  acts  upon  this  substance,  the  pre- 
sence of  which  is  proved  in  every  case  of  Cholera; 
and  he  continues  the  use  of  calomel  until  it  is  suf- 
ficiently apparent  in  the  alvine  evacuations.    From 


75 

three  to  five  scruples  of  calomel  are  usually  neces- 
sary for  the  accomplishment  of  this  object. 

This  method  of  treatment  was  also  that  of  Doctor 
Corbin;  which  the  Marquis  of  Hastings  caused  to  be 
adopted  generally,  by  putting  it  in  the  order  of  the 
day  of  the  whole  English  army. 

Doctor  Jameson  directs  calomel  as  a  means  of 
overcoming  the  spasms  of  the  intestines. 

In  some  cases  aloes  are  combined  with  the  calo- 
mel, especially  when,  from  the  urgency  of  the 
symptoms,  it  becomes  necessary  to  hasten  the  ap- 
pearance of  green  or  yellow  bile  in  the  substances 
voided,  an  appearance  which  is  always  a  favourable 
omen. 

Opium.  What  we  have  said  of  calomel,  we  may 
equally  affirm  of  opium  :  patients  cured  as  well  as 
those  who  have  died,  all  have  taken  it,  and  that  in 
conjunction  with  calomel  at  first,  but  also  concur- 
rently with  aromatics  and  tinctures  of  various  kinds. 
It  is  always  the  opiacious  preparation  of  Syden- 
ham* to  which  the  preference  is  given,  and  we  know 
that  in  this  compound,  the  opium  is  found  combined 
with  spirituous  and  aromatic  substances. 

Let  us  here  bring  to  mind,  that  Bontius,  who  ob- 
served the  Cholera  in  India  in  the  catastatic  state,  or 


*  Tinctura  Opii  Crocata,  R.  Opium  16.  Saffron  8.  Cinnamon  and 
Cloves  aa  L  Spanish  Wine  150. — Tr. 


76 

that  of  the  minor  epidemic  in  1669,  combated  it  with 
great  success  by  means  of  a  preparation  which  is 
peculiar  to  him,  and  in  which  the  opium  is  found 
united  with  aromatic  resinous  substances. 

Many  facts  tend  to  shed  suspicions  upon  the  effi- 
cacy of  opium  employed  alone  :  it  then  too  fre- 
quently produces  a  violent  determination  towards 
the  brain ;  and  in  the  series  of  the  symptoms  of 
Cholera  we  observe  a  great  degree  of  stupor,  coma, 
and  sometimes,  though  very  rarely,  delirium.  These 
inconveniences  have  not  taken  place  where  the 
opium  has  been  combined  with  calomel,  camphor, 
ether,  or  liquid  ammonia. 

Mr.  Deville  surgeon  of  the  French  ship  la  Seine, 
who  has  seen  and  attended  the  epidemic  cholera  in 
Bengal,  obtained  instantaneous  relief  and  even  the 
prompt  cessation  of  all  the  symptoms  of  cholera,  by 
the  aid  of  large  doses  of  Ether,  administered  from 
the  first  moments  of  the  invasion  of  the  disease.  We 
read  in  his  work  a  great  number  of  facts  in  support 
of  this  assertion. 

Aromatic  infusions,  sometimes  aqueous,  at  other 
times  spirituous,  often  present  themselves  among 
the  auxiliaries  of  the  treatment  of  the  cholera  in  In- 
dia; we  might  say  the  same  of  acid  drinks  and 
especially  of  the  tartaric  lemonade,  which  Annesley 
extolled,  and  which  he  did  not  fear  giving  cold,  as 
well  as  all  other  drinks ;  which  he  even  prefers  ad- 


77 

ministering  at  this  temperature,  after  the  example 
of  Galen,  of  Celsus  and  Hoffman,  notwithstanding 
the  contrary  has  been  advised  by  almost  all  physi- 
cians who  have  practised  in  this  country  and  in  the 
midst  of  this  epidemic. 

It  is  exclusively  by  warm  baths  that  Hippocrates 
encountered  the  cholera-morbus.  The  warm  bath, 
in  the  epidemic  of  India,  has  been  a  matter  of  great 
controversy  ;  lauded  by  some,  always  at  a  high 
temperature,  they  have  been  proscribed  by  many 
others  especially  on  account  of  the  humidity  and 
coldness  which  their  use  inevitably  occasions,  in 
spite  of  the  greatest  precautions. 

Rubefacients  of  all  kinds  and  in  every  degree 
have  been  employed,  with  the  intent  of  recalling 
vitality  to  the  circumference,  of  reanimating  the 
circulation  and  exciting  warmth  in  the  cold  surface 
of  the  skin  ;  but.  generally  siiiapisms  have  been  pre- 
ferred. 

The  private  correspondent  of  our  very  zealous 
colleague  M.  Reveille  Parise,  has  informed  him  that 
at  Batavia  they  have  ascertained  the  dangers  of 
every  emission  of  blood  in  the  epidemic  cholera, 
and  that  they  there  administer  with  almost  constant 
success,  a  mixture  of  two  parts  of  essence  of  mint 
(spiritus  menthae)  and  one  part  of  laudanum.  In 
Russia  as  well  as  in  India,  we  almost  always  find 
the  essence  of  mint  associated  with  opium. 

8* 


78 

In  passing  from  Asia  into  Europe,  the  therapeu- 
tics of  the  epidemic  cholera  have  not  made  any  very 
important  acquisitions ;  scarcely  have  the  physi- 
cians of  Russia  added  any  thing  to  the  treatment  re- 
capitulated of  the  physicians  of  India.  All  that  we 
have  seen  in  the  Indian  therapeutics  is  to  be  found 
in  that  of  the  Russians.  Among  the  latter  however 
calomel  seems  to  have  been  a  little  less  in  vogue  ; 
its  advantages  have  been  less  highly  extolled,  the 
insufficiency  of  it  has  been  more  candidly  admitted, 
it  has  been  given  in  smaller  doses  and  with  less  per- 
sistency, and  some  physicians  have  even  totally 
proscribed  the  use  of  it. 

But  now,  bleeding  especially  at  the  beginning  of 
the  disease  and  sometimes  also  in  its  advanced 
stages ;  calomel  almost  always  combined  with  opi- 
um ;  aromatics ;  diffusible  stimulants,  such  as  ether, 
volatile  alkali,  camphor,  musk  ;  vapour  baths,  sand 
baths,  baths  with  a  strong  decoction  of  hay  ;  some- 
times purgatives,  and  especially  torrified  rhubarb  for 
the  purpose  of  overcoming  the  obstinate  constipation 
which  persists  during  the  convalescence :  such  in 
short,  has  been  the  therapeutics  of  the  Russian  phy- 
sicians against  the  epidemic  cholera.  Nitrous  ether,* 
oxygenated  muriatic  acid  diluted  with  water,  have 


*  Alcool  nitrique. 


79 

been  equally  tried  with  some  appearance  of  suc- 
cess. 

It  has  sometimes  been  observed  that  opium  in 
large  doses  augmented  the  intensity  of  the  contrac- 
tions of  the  extremities ;  and  it  is  in  these  cases  that 
camphor,  ether,  and  musk  have  been  administered 
with  advantage. 

Riverius'  draught  has  been  constantly  advised  and 
prescribed  in  order  to  allay  the  vomiting  ;  and  we 
may  observe  that  this  symptom  is  most  fatiguing 
and  most  obstinate  in  persons  addicted  to  intoxica- 
tion and  gluttony. 

Against  the  cramps  of  the  inferior  and  superior 
extremities,  in  addition  to  the  baths  of  which  we 
have  spoken,  we  also  find  indicated  dry  frictions, 
frictions  with  spirits  of  camphor,  and  aromatic  cat- 
aplasms. 

It  is  especially  in  powder  and  united  with  pulver- 
ised gum  Arabic,  that  the  Russians  recommend  the 
administration  of  calomel.  On  this  subject,  they 
call  the  attention  very  particularly  to  the  astonish- 
ing capability  of  the  patient  to  bear  strong  doses  of 
this  substance  without  its  determining  any  of  those 
bad  consequences  so  frequently  formidable  in  other 
cases  of  disease. 

Injections  with  the  decoction  of  bran  or  starch, 
to  which  laudanum  was  added,  were  administered 
for  the  diarrhoea,  to  which  were  also  opposed  ene- 


80 

mata  consisting  of  decoctions  of  small  bitter  oranges, 
gum  arabic  and  opium. 

The  private  correspondents  of  the  Academy  have 
informed  us  that  very  skilful  physicians  had  given 
the  extracts  of  hyosciamus  and  cicuta  with  remark- 
able success.  Dr.  Haaz  boasts  particularly  of  the 
extract  of  nux  vomica. 

Doctor  Foy  proposes,  as  capable  of  modifying 
the  nervous  state  in  cholera,  the  distilled  water  of 
the  cherry  laurel  and  the  distilled  water  of  bitter 
almonds.  It  would  be  well  however  to  mistrust  the 
effects  which  these  means  may  produce  at  that  stage 
of  the  disease  in  which  the  oppression  of  the  forces 
constitute  the  only  symptom  of  it. 

At  Warsaw,  Dr.  Leo  was  convinced  that  the  dis- 
ease presented  no  inflammatory  character.  He  con- 
sequently opposed,  in  a  general  manner,  every  idea 
of  blood-letting.  To  him  blood-letting  most  fre- 
quently seemed  dangerous. 

Calomel,  according  to  him,  vainly  irritates  the 
intestinal  canal  and  also  augments,  with  additional 
dangers,  the  alvine  evacuations. 

Opium  given  in  small  doses  remains  without  ef- 
fect ;  and  if  we  increase  the  quantity  of  it,  it  dimin- 
ishes, it  is  true,  the  vomiting  and  stools,  but  it  kills, 
says  Dr.  Leo,  by  the  narcotic  excitations  which  it 
impresses  upon  the  economy. 

For  these  means  Dr.  Leo  substitutes  what  he  calls 


81 

"  his  method,"  of  which  the  following  is  the  sub- 
stance. He  administers  every  two  or  three  hours 
three  grains  of  the  sub-nitrate  of  bismuth,  in  powder, 
combined  with  sugar.  At  the  same  time  he  gives 
an  infusion  of  balm,  and  directs  frictions  with  a 
heated  mixture  of  compound  alcoholic  tincture  of 
angelica  and  liquid  ammonia  to  be  applied  to  the 
superior  and  inferior  extremities.  At  a  later  period 
he  orders  some  doses  of  torrified  rhubarb  in  powr- 
der ;  but  he  very  particularly  insists  upon  the  bismuth 
in  powder,  and  he  affirms  that  he  has  not  seen  one 
of  the  numerous  patients,  who  have  been  treated  in 
this  manner,  perish :  the  cure  has  in  general  been 
accomplished  at  the  end  of  five  days.  In  the  opinion 
of  Dr.  Leo,  blood-letting  was  but  rarely  admissible, 
and  only  in  young  individuals  of  a  robust  constitu- 
tion. 

M.  Briere  de  Boismont  in  one  of  his  letters  to 
our  colleague  Dr.  Esquirol,  confirms  the  advantages 
of  this  method  in  some  cases.  Every  thing  goes 
wrong  in  the  midst  of  epidemic  tumult:  M.  Briere 
de  Boismont  announces,  in  the  same  letter,  that  he 
has  found  considerable  quantities  of  sublimate  in  the 
calomel  iidministered  at  Warsaw. 

If  we  have  succeeded  in  rendering  the  general 
idea,  which  it  is  proper  to  form  of  the  epidemic 
cholera,  precise ;  if  we  have  determined  the  true 
nature  of  it,  and  if  the  disease  actually  consists  in  a 


82 

diminution  of  the  innervation,  in  a  vicious  direction 
of  this  innervation  concentrated  upon  the  internal 
organs,  combined  with  a  particular  catarrhal  affec- 
tion of  the  gastro-intestinal  mucous  membranes,  we 
will  easily  succeed  in  establishing  the  therapeutic 
methods  best  calculated  to  subdue  this  disease,  and 
in  comprehending  the  effects  of  those  which  have 
been  advantageously  employed. 

One  prominent  fact  strikes  us,  in  deeply  medita- 
ting upon  the  means  by  the  aid  of  which  they  have 
combated  the  cholera  in  those  parts  of  the  East  In- 
dies, of  Russia  and  Poland  wThere  it  has  been  observ- 
ed ;  it  is  the  attempt  which  has  been  made  both  in 
Asia  and  Europe  to  discover  an  uniform,  identical 
method  of  treatment,  for  all  the  individuals  attacked 
with  the  disease,  and  hence  the  total  inefficiency  of 
the  attempt.  Thus  we  very  evidently  have  seen 
that  the  means  which  have  succeeded  in  some  cases 
have  been  unsuccessful  in  others.  Blood-letting 
which  appeared  beneficial  in  a  great  number  of  in- 
dividuals, has  been  evidently  injurious  in  many 
others.  Calomel,  which  seemed  to  succeed  so  fre- 
quently in  the  Indies,  has  often  failed  at  Moscow 
and  at  Warsaw.  Opium,  extolled  beyond  measure 
by  the  Indian  practitioners,  has  produced,  under 
the  inspection  of  the  Russian  physicians,  an  aug- 
mentation of  the  spasmodic  movements  pertaining  to 
the  disease :  whence  it  follows  that  there  does  not 


83 

exist,  in  the  epidemic  cholera,  an  uniform,  constant 
treatment  applicable  to  all  cases. 

This  conclusion,  which  is  also  true  with  regard 
to  all  epidemics,  we  find  explicitly  admitted,  and  in 
a  very  positive  manner,  by  Dr.  James  Boyle,  who 
has  for  a  long  time  studied  the  epidemic  cholera  in 
India.  He  says  positively,  page  13  of  his  Treatise, 
that  we  can  adopt  no  uniform  method  of  treatment 
for  all  the  cho.lericks  ;  that  we  must,  on  the  contra- 
ry, vary  the  treatment  according  to  each  particular 
case.  It  is,  he  adds,  in  consequence  of  having  indis- 
criminately put  in  practice,  sometimes  blood-letting, 
at  other  times  calomel,  here  opium,  there  warm 
baths,  that  the  physician  has  obtained  so  little  suc- 
cess. Dr.  Boyle  relates  a  great  number  of  exam- 
ples of  blood-letting  practised  unsuccessfully  at  the 
period  when  the  blood  still  escaped  freely  from  the 
vein.     The  patients  have  sunk. 

According  to  the  opinion  of  Dr.  Christie,  we  must 
endeavour  to  appreciate  the  indications  in  this  dis- 
ease accurately :  and  in  order  to  fulfil  them  we  must 
employ  different  medicines  according  to  circum- 
stances :  we  cannot  hope  to  find  a  specific  applica- 
ble to  all  cases  of  cholera,  no  more  than  we  can  in 
a  great  number  of  other  diseases.  In  this,  as  in 
many  others,  we  must  expect  every  thing  from  the 
tact  and  the  judgment  of  the  physician. 

M.  Meusnier,  Doctor  of  the  faculty  at  Paris,  con- 


84 

sular  agent  of  France  at  Tangaroc,  in  his  letter  to 
the  Academy  upon  the  epidemic  cholera,  thus  ex- 
presses himself:  "  an  absolute  medicament  cannot 
be  pointed  out,  since  blood-letting,  drastics,  acids, 
narcotics,  the  warm  bath,  and  ice,  have  each  in  their 
turn  had  their  successes  and  reverses.  It  is  espe- 
cially in  the  idiosyncracy  that  the  general  indica- 
tions reside  ;  it  is  thence  we  must  derive  the  choice 
of  the  means  which  it  is  proper  to  employ." 

In  therapeutics,  there  is  no  rule  of  absolute  per- 
fection out  of  which  every  thing  is  wrong  and  only 
leads  to  error.  Individualities,  which  vain  efforts 
of  abstraction  have  so  often  endeavoured  to  oblite- 
rate, are  always  there,  with  their  peculiar  consti- 
tutions and  their  special  idiosyncracies,  in  order  to 
change  general  predictions  and  command  numerous 
exceptions.  These  individualities,  which  often  mod- 
ify in  a  special  manner  the  morbid  conditions,  also 
demand  a  modification  of  the  therapeutic  agents. 
The  great  epidemic  now  under  consideration,  is  a 
living  proof  of  it.  Without  doubt  it  presents  capi- 
tal, general  indications,  and  which  may  be  syntheti- 
cally expressed ;  but  it  also  presents,  in  individual 
constitutions,  in  the  variation  of  symptoms,  and  in 
the  organic  susceptibilities,  other  indications  of  vast 
importance. 

To  re-animate  the  general  action  of  the  innerva- 
tion, and  to  render  the  distribution  of  the  nervous 


85 

function  more  regular ;  to  stimulate  and  warm  the 
cold  surfaces  of  the  skin ;  to  call  life  and  motion 
from  the  centre  to  the  circumference :  such  is  the 
predominant  capital  indication  in  the  epidemic 
Cholera. 

To  attack  at  the  same  time  the  catarrhal  affec- 
tion by  the  aid  of  means,  the  happy  effects  of  which 
have  been  ascertained  from  experience,  constitutes 
another  analytic  indication  of  nearly  equal  im- 
portance. 

Finally,  to  combat  the  symptoms  in  proportion 
to  their  relative  predominancy,  is  a  secondary  or 
symptomatic  indication,  which  should  not  be  neg- 
lected any  more  than  the  others. 

With  a  view  of  fulfilling  the  indication  relative  to 
the  innervation,  diffusible  stimulants  and  antispas- 
modics doubtless  claim  the  first  place.  Thus  the 
physicians  of  Orenburg  have  given,  with  success, 
a  mixture  of  Hoffman's  elixir*  and  essence  of  mint. 
This  remedy  had  become  so  extensively  popular, 
that  every  body  took  it  by  the  title  of  preservative. 

It  is  thus  that  Doctor  Noel,  when  a  considerable 
body  of  the  French  army,  disembarked  on  the  Cor- 
omandel  coast,  were  attacked  with  Cholera,  gave 


*  R.  Peruvian  bark,  orange  peel  and  sub-carbonate  of  potassa 
aa  2.  Extracts  of  holy-thistle,  of  small  centaury,  and  of  myrrh 
aa  1  ;  Madeira  wine  48. — Tr. 


86 

divided  doses  of  volatile  alkali  in  sweetened  infusion 
of  balm  with  great  success. 

It  was  also  with  the  same  object  that  M .  Deville 
prescribed,  at  Calcutta,  strong  doses  of  ether,  from 
the  very  commencement  of  the  disease. 

It  is,  finally,  in  the  same  manner  that  are  con- 
ceived and  explained  the  advantages  so  frequently 
derived,  at  Batavia,  from  the  mixture  of  two  parts 
of  the  essence  of  mint  and  one  part  of  laudanum, 
the  use  of  which  was  persisted  in  until  the  cure  was 
accomplished. 

Blood-letting,  in  young,  plethoric  individuals,  of  a 
robust  constitution,  administered  at  the  onset  of 
the  disease,  immediately  produces  the  restoration  of 
the  vital  powers  ;  it  revives  the  circulation  at  the  cir- 
cumference, and  calls  the  blood  and  the  heat  to 
the  pale  and  chilled  surface  of  the  body.  It  is  then 
with  this  view,  and,  under  the  influence  of  these  cir- 
cumstances, that  blood-letting  has  been  advised  and 
performed  ;  but  in  subjects  of  a  feeble  constitution, 
or  accidentally  debilitated,  and  at  an  advanced 
period  of  the  disease,  the  abstraction  of  blood  has 
been  very  often  prejudicial. 

In  the  series  of  remedies  successfully  administer- 
ed against  the  catarrhal  affection,  calomel  holds  the 
first  place,  and  is  given  in  powder  combined  with 
gum  arabic.  Doctor  Christie,  in  his  interesting  work 
on  Cholera,  has  established  that  it  is  to  this  affection 


87 

especially  that  calomel  is  applicable.  It  is  also 
against  this  state  of  the  mucous  membranes  that 
Annesley  prescribes  calomel,  in  scruple  doses,  every 
three  hours ;  often,  he  combines  it  with  aloes,  in 
order  to  obtain  more  promptly  the  evacuation  of 
the  creamy  matter  which  fills  the  intestines.  The 
bitter  tincture,  in  the  opinion  of  Annesley,  brings 
about  the  same  effect 

Here  also  internal  stimulants  are  properly  ar- 
ranged, in  the  number  of  which  M.  Christie  places 
the  capsicum  in  particular  :  as  also  external  stim- 
mulants,  giving  preference  to  the  stimulation  pro- 
duced by  the  application  of  vesicatories.  Cata- 
plasms containing  a  large  quantity  of  mustard,  ap- 
plied early  and  retained  constantly  upon  the  whole 
extent  of  the  spinal  column,  will  be  very  efficacious 
in  re-animating  the  innervation  and  in  producing  re- 
action to  the  circumference. 

Doctor  Poupireff  has  ascertained,  in  the  govern- 
ment of  Orenburg,  the  good  effects  of  the  serpen- 
taria  virginiana,  when  associated  with  cinchona,  in 
reviving  the  nervous  energy  and  restoring  vitality  to 
the  circumference.  Annesley  also  advises  the  bark, 
in  powder,  either  by  itself  or  combined  with  aro- 
matics.  But  under  circumstances,  where  it  is  so  im- 
portant to  guard  against  the  susceptibility  of  the 
stomach,  how  is  it  that  the  sulphate  of  quinine  has 
not  been  thought  of  ?  combined  with  musk,  with  the 


88 

essence  of  mint,  camphor,  or  ether,  this  would  cer- 
tainly be  a  powerful  means  of  assistance.  We 
have  not  observed  that  the  sulphate  of  quinine  has 
been  placed  among  the  number  of  remedies  ad- 
ministered against  Cholera. 

With  the  title  of  diffusible,  and  for  the  purpose  of 
producing  re-action,  Dr.  Milwood  has  extolled 
James'  powder ;  and  it  is  with  the  same  views  that 
the  Dover's  powder  has  been  given.  Cupping  would 
also  possess  numerous  advantages  in  endeavouring 
to  restore  vitality  to  the  periphery. 

Most  of  the  articles  recommended,  for  the  cure 
of  this  epidemic,  both  in  India  and  in  Russia,  were 
manifestl v  intended  to  change  the  direction  of  the 
movements,  and  occasion  re-action  from  the  centre 
to  the  circumference  :  as,  for  instance,  frictions,  lin- 
iments of  every  kind,  baths  of  warm  sand  or  of 
roasted  bran,  vapour  baths,  ordinary  baths  at  high 
temperature,  &c. 

In  attacking  then  the  two  general  causes  of  the 
disease  by  means  applicable  to  the  individualities, 
we  will  doubtless  oppose  the  symptoms  which  are 
the  consequence  or  the  effect  of  them  ;  but  it  is  in 
the  epidemic  Cholera  especially  that  we  must  pay 
attention  to  the  various  indications  resulting  from 
the  different  stages  of  the  disease,  and  the  symp- 
toms which  constitute  them. 

Thus  opium,  which  acts  as  a  powerful  sedative, 
quiets  the  vomitings  and  arrests  the  diarrhoea ;  it 


89 

also  diminishes  the  irritability  of  the  system,  and 
advantageously  modifies  the  altered  secretions  of 
the  intestinal  mucous  membrane. 

The  sub-nitrate  of  Bismuth  seems  to  have  all  the 
advantages  of  opium,  without  possessing  any  of  its 
inconveniences ;  however,  notwithstanding  the  at- 
tempts of  Doctors  Odier  and  Marcet,  the  thera- 
peutic value  of  this  substance  has  not  yet  been 
definitively  determined. 

Frictions,  to  the  superior  and  inferior  extremities, 
with  the  oil  of  turpentine,  cannot  fail  to  be  advan- 
tageous in  contending  with  the  cramps. 

Against  the  constipation  which  supervenes  during 
convalescence,  rhubarb,  magnesia  and  calomel  have 
been  given. 

The  applications  of  leeches,  at  the  onset  of  the 
disease,  cataplasms  and  sedative  liniments,  often 
successfully  overcome  the  epigastric  anxieties  and 
pains :  general  bloodletting  would  be  preferable  for 
the  removal  of  internal  inflammation,  in  those  cases 
in  which  either  the  symptoms  or  the  consecutive 
occurrences  denote  its  existence. 

The  vomiting  is,  without  contradiction,  the  most 
obstinate  and  most  distressing  symptom  of  this  dis- 
ease. Riverius'  draught  arrests  the  vomitings,  and 
opium  might  also  be  administered  with  some  pros- 
pect of  success.  Injections,  containing  a  pretty 
large  quantity  of  laudanum,  thrown  into  the  rectum, 

9* 


90 

are    efficacious    in    stopping    the   alvine   evacua- 
tions. 

It  is  especially  towards  the  diminution  of  the 
evacuations  that  the  symptomatic  indications  should 
tend.  Nothing  leads  more  rapidly  to  the  destruc- 
tion of  the  strength,  nothing  hastens  more  speedily 
the  progress  of  the  most  formidable  symptoms,  than 
the  frequency  of  the  vomitings  and  stools.  Not 
only  does  every  medication,  every  reparation,  then 
become  impossible,  but  there  also  results  a  general 
exhaustion  and  absolute  loss  of  every  vital  resist- 
ance, by  the  deperditions  and  lassitude  which  the 
incessantly  returning  calls  for  these  continual  de- 
jections occasion. 

Again  let  us  repeat  that  in  order  to  direct  suc- 
cessfully the  therapeutic  of  Cholera,  we  must  not 
lose  sight  of  the  two  constituent  elements  of  this 
disease  ;  and  especially  is  it  necessary  to  apprehend 
clearly  the  indications  which  flow  from  them. 

It  is  very  essential  to  attack  each  of  these  ele- 
ments in  the  order  of  their  respective  predominance, 
that  is,  attend  to  the  catarrhal  indication  when  that 
is  most  prominent ;  and  to  the  nervous  indications 
when  they  bear  the  sway. 

We  must  not  omit  saying,  that,  in  this  dreadful 
combination  of  pathological  disturbances,  as  in  all 
complications  of  disease,  it  is  often  sufficient  to 
attack  successfully  one  of  the  agents,  especially  the 


91 

predominant  agent,  in  order  to  insure  the  cure  of 
the  patient.  The  powers  of  the  organism  though 
apparently  annihilated,  and  thus  the  most  promi- 
nent feature  in  the  disease,  have  shown  themselves 
quite  sufficient  to  work  out  the  cure  of  the  complaint 
thus  simplified  or  reduced. 

Unfortunately  there  are  no  cases  on  record,  of 
cholera  regularly  observed  when  left  to  the  action 
of  the  powers  of  nature  alone,  independently  of 
every  medical  modification.  Consequently  we  can- 
not compare  this  order  of  facts  and  their  results 
with  the  results  obtained  by  the  combined  assist- 
ance of  nature  and  of  art.  It  would  especially  be 
necessary  to  establish  the  comparison  of  these  facts 
in  the  midst  of  analogous  conditions,  favourable  or 
the  reverse,  that  is  to  say,  with  equal  chances  of 
safetv  or  destruction. 

We  might  advance,  however,  in  a  general  man- 
ner, that  those  unfortunates,  who,  impelled  by  fatal- 
ism, blinded  by  ignorance,  or  abandoned  to  the 
desolation  of  poverty,  have  not  been  assisted,  have 
almost  all  died  ;  but,  independently  of  the  vagueness 
of  this  assertion,  we  should  not  forget  that,  in  these 
cases,  the  patients  of  this  class  were  not  in  equal 
conditions  with  others ;  these,  from  the  simple  fact 
of  their  position,  were  placed  in  the  midst  of  those 
conditions  in  which  the  epidemic  proves  most  de- 
structive, such  as  want,  poverty,  uncleanness,  &c. 


PART  SIXTH. 


GEOGRAPHICAL  MARCH  AND   MODE  OF   EXTEN- 
SION OF  THE  DISEASE  IN  ASIA. 

Having  exposed  the  series  of  changes  developed 
in  individuals  attacked  with  Cholera,  we  are  now 
about  to  give  a  rapid  sketch  of  the  course  of  the 
disease  through  the  different  places  which  have 
been  the  theatre  of  it.  In  other  terms,  having  re- 
capitulated the  pathological  march  of  the  disease, 
let  us  also  endeavour  to  give  a  summary  of  its  geo- 
graphical route.  We  shall  see  whether,  from  these 
investigations,  any  new  data  will  arise  for  the  solu- 
tion of  the  problems  which  have  been  proposed  to 
us. 

We  have  not  forgotten  to  mention,  and  we  have 
the  design  to  prove  that,  at  all  times,  in  India,  that 
is  to  say,  since  this  country  has  been  medically  ex- 
plored, the  Cholera  has  been  observed  there  in  the 
sporadic  state,  in  the  endemic  state,  and  in  the  ca- 
tastatic  state. 

Observation  rested  at  this  point  when,  in  1817, 
the  scourge  under  consideration  broke  out  in  the 
eastern  regions  of  the  Peninsula  of  India. 


93 

Let  us  mention  here,  however,  that  long  previous 
to  1817,  in  the  year  1783,  we  find  two  facts,  at 
least,  of  this  severe  epidemic  in  India. 

The  first  occurred  in  Hurdwar,  where  the  Gan- 
ges takes  its  source.  This  country,  regarded  as 
sacred,  is  the  rendezvous  of  a  famous  pilgrimage, 
which  takes  place  there  every  year,  and  of  an  ex- 
tensive pilgrimage,  much  more  famous  still,  which 
is  renewed  every  twelfth  year  only :  1783  was  one 
of  these  twelfth  years. 

A  fabulous  number  of  pilgrims  were  there  con- 
gregated together  upon  the  borders  of  the  river, 
where  they  passed  the  night,  poorly  nourished, 
badly  clothed,  in  the  midst  of  all  the  filth  of  pov- 
erty and  excess  of  debauchery.  This  year  the 
Cholera  broke  out  at  the  commencement  of  the  sa- 
cred ceremonies.  In  less  than  eight  days,  the  disease 
counted  twenty  thousand  victims  ;  yet,  neverthe- 
less was  so  slightly  propagated,  that  it  did  not  reach 
even  the  village  of  Juwallapore.  situated  seven  miles 
distant.  The  epidemic  ceased  at  the  same  time 
with  the  pilgrimage  and  the  ceremonies  which  were 
connected  with  it. 

Second  fact.  In  the  northern  Circars,  a  very 
narrow  tongue  of  land  on  the  sea  coast,  encamped 
a  division  of  a  thousand  artillerists,  under  the  com- 
mand of  Colonel  Pearce.  In  the  spring  of  1781, 
this  detachment  proceeded  to  rejoin  the  main  body  of 


94 

the  army  encamped  upon  the  coast.  The  epidemic 
Cholera  attacked  this  detachment.  The  disease 
was  rapidly  fatal ;  the  catastrophe  happened  at  the 
expiration  of  a  few  minutes,  and  in  the  midst  of  in- 
tolerable spasms.  It  was  death,  says  Colonel  Pearce, 
and  not  disease,  that  reigned  in  the  camp.  Out  of 
one  thousand  soldiers  about  seven  hundred  died. 
The  epidemic  ceased  at  the  end  of  six  days  in  con- 
sequence of  changing  the  station. 

In  this  epidemic,  says  the  historian,  a  frequent, 
but  perhaps  exaggerated,  use  was  made  of  the  an- 
timoniated  tartrate  of  potass.* 

This,  we  may  add,  is  one  of  the  rare  instances 
in  which  the  emetic  has  been  administered  in 
Epidemic  Cholera. 

In  the  same  country,  in  1790,  Colonel  Cockerel, 
experienced  similar  misfortunes  among  the  troops 
which  he  commanded  in  that  station ;  but  in  a  less 
violent  degree. 

However,  it  is  at  Jessore,  a  city  situated  thirty- 
three  leagues  north-east  from  Calcutta,  in  the  Delta 
of  the  Ganges,  that  this  scourgo  really  manifested 
itself  for  the  first  time.  In  the  afternoon  of  the 
19th  of  August,  1817,  Doctor  Robert  Tytler  was 
called  to  see  a  Hindoo  who,  during  the  preceding 
night,  had  been  attacked  with  evacuations  both  up- 


*  Tartar  Emetic. 


95 

wards  and  downwards,  accompanied  with  the  most 
atrocious  pains.  The  patient  died  the  day  follow- 
ing, without  any  person  so  much  as  dreaming  of 
the  Cholera-morbus.  At  a  distance  from  the  place 
some  just  suspicion  was  entertained  of  poisoning 
by  the  datura  stramonium,  inasmuch  as  the  patient 
was  to  have  appeared  on  the  following  day  as  wit- 
ness in  a  criminal  cause.  But  on  the  morning  of 
the  20th  of  August,  it  was  ascertained  that  ten 
other  individuals,  in  the  same  corner  of  the  ba- 
zaar, had  died  with  almost  the  same  symptoms, 
and  that  seven  others  had  perished  likewise;  it  was 
also  known  that  the  disease  had  invaded  several 
divisions  of  the  city.  Doctor  Tytler  attributed  the 
disease  to  the  bad  quality  of  the  rice,  which,  we 
know,  is  the  food  of  the  Indians. 

Nevertheless,  the  number  of  victims  increased 
from  day  to  day.  Soon  was  it  ascertained  that  the 
disease  had  already  made  its  appearance,  in  the 
month  of  May,  in  some  parts  of  Nuddeca,  as  well 
as  in  some  other  parts  of  the  surrounding  districts, 
and  that  it  reigned  in  all  the  country  comprised  be- 
tween Siipet  and  Monghir,  even  from  the  mouths 
of  the  Gauges  to  its  junction  with  the  Jumna. 

Already  at  this  epoch,  one  was  struck  with  the 
singular  mode  of  propagation  of  this  disease.  Often 
by  its  ravages,  it  described  a  complete  circle  around 
a  place,  without  at  first  penetrating  into  it,  and  then 


96 

removed  to  a  distance  ;  so  that  it  might  be  consider- 
ed free  from  danger,  when  suddenly  it  returned  sev- 
eral weeks  or  even  months  afterwards.  It  has 
also  been  seen  to  ascend  and  descend,  for  a  con- 
siderable distance,  one  of  the  banks  of  the  Ganges, 
then  stop  suddenly,  leap  across  the  river,  and  re- 
commence its  ravages  on  the  opposite  bank. 

Let  us  dwell  for  a  moment,  it  is  necessary  we 
should,  on  this  first  appearance  of  the  disease. 
The  Cholera  had  reigned  epidemically,  during  the 
first  six  months  of  1817,  in  the  country  of  Nuddeca 
and  its  environs :  whilst  the  neighbouring,  sur- 
rounding villages  remained  entirely  unmolested, 
the  citv  of  Jessora  and  those  of  the  districts  round 
about  were  ravaged ;  a  great  number  of  dis- 
tricts remote  from  one  another  have  been  invaded 
simultaneously  or  at  very  short  intervals,  whilst 
others  much  nearer  were  respected.  Here  then  the 
disease  was  not  extended  by  any  of  the  means  of 
successive  transmission,  and  it  must  be  admitted, 
without  a  possibility  of  contradiction,  that  it  was 
primitively  established  under  the  action  of  occult, 
general  causes,  that  is  to  say,  by  the  epidemial 
influence. 

At  Calcutta,  the  Cholera  manifested  itself  for  the 
first  time  early  in  the  month  of  August,  scarcely  one 
month  after  its  appearance  at  a  distance  of  one  hun- 
dred miles  from  that  place  :  it  seemed  to  gain  ground 


97 

more  and  more  :  but  it  did  not  attain  its  acme  until 
the  first  days  of  the  month  of  September.  The 
number  of  victims  was  seldom  less  than  two  hun- 
dred a  week,  in  a  population  of  a  million  of  inhabit- 
ants. The  disease  was  much  more  destructive, 
when  on  the  7th,  according  to  others,  the  9th, 
of  November,  it  attacked,  in  taking  a  direction 
from  east  to  west,  the  army  encamped  on  the 
right  bank  of  the  Betoah,  and  concentrated  at  Jub- 
belpore,  Mendelloa  and  Sanger.  The  Cholera- 
morbus  made  such  terrible  ravages  in  this  army, 
composed  often  thousand  English  and  eighty  thou- 
sand natives,  that  a  multitude  of  domestics  and 
other  individuals  in  the  train  of  the  troops  expired 
in  a  few  minutes.  Those  who  lived  on  vegetable 
substances  were  first  taken  off;  women  and  chil- 
dren seemed  to  be  spared  :  but,  remarkable  cir- 
cumstance, so  sudden  as  was  the  invasion  of  the 
disease,  so  prompt  was  its  cessation.  When  the 
army  had  crossed  the  river  Betoah,  taking  up  its 
march  along  its  eastern  side,  the  Cholera  was,  as 
it  were,  cut  off.  The  number  of  those  who  died 
and  fled,  during  the  six  days  in  which  this  epidemic 
continued,  is  estimated  at  from  twenty  to  twenty- 
five  thousand  :  according  to  other  data,  however, 
the  number  of  the  dead  could  have  been  only  three 
thousand. 

10 


98 

In  the  same  month,  and  in  the  same  week,  the  dis- 
ease reigned  in  the  districts  of  Behar  and  Dacca,very 
remote  from  and  entirely  foreign  to  one  another ; 
it  also  existed  in  the  cities  of  Patna  and  Dacca, 
which  are  several  hundred  miles  asunder. 

Irresistible  in  its  march,  the  Cholera-morbus  ex- 
tended in  a  short  time  over  the  broadest  part  of 
the  peninsula  of  India,  ravaging  successively  the 
cities  and  neighbourhood  of  Nagpore,  Aurengabad, 
Ahmednagour  and  Pounah,  in  the  direction  of  which 
great  military  movements  were  then  going  on. 

On  the  11th  of  August  1820,  the  Cholera  broke 
out  at  Bombay,  and  carried  off,  previous  to  the 
month  of  February  following,  eleven  hundred  and 
thirty  three  victims :  again  in  the  month  of  Sep- 
tember 1821  it  returned,  accompanied  with  exces- 
sive heat,  when  it  destroyed,  from  the  23d  to  the 
28th  of  the  month,  two  hundred  and  thirty-five 
persons. 

Pursuing  the  course  of  the  Nerbudda,  in  an  east- 
ern  direction,  the  disease  arrived  at  Haschungabad. 
Beyond  the  river,  in  the  southern  direction,  it  was 
observed  in  the  city  of  Moltay,  towards  Nagpore. 
These  two  places,  and  a  great  number  of  interme- 
diate villages,  had  much  to  suffer ;  the  city  of  Mol- 
tay alone,  though  inconsiderable,  lost  five  hundred 
inhabitants :  but  between  Nagpore  and  Moltay,  all 
the  country,  which  embraces  about  seventy  miles, 


99 

remained  unmolested ;  and  Baitool,  a  large  city 
situated  directly  between  the  river  and  Moltay,  was 
not  attacked  by  it 

The  auxiliary  troops  of  Nagpore,  commanded  by 
Col.  Adam,  afforded  the  first  striking  example  of  a 
numerous  body  of  men  penetrating  into  the  epi- 
dermal region,  and  suddenly  falling  from  a  state 
of  perfect  health  into  a  desperate  state  of  disease. 
On  the  first  of  June,  the  division  quitted  Nagpore, 
in  order  to  return  to  the  cantonments  of  Haschung- 
abad  ;  the  disease  then  gradually  diminished,  and 
on  the  17th  and  18th  of  the  same  month  almost 
entirely  disappeared. 

Let  us  follow  the  epidemic  towards  the  junction 
of  the  Ganges  and  Jumna  at  Allahabad,  and  in  a 
great  part  of  these  provinces  of  the  north.  The 
Cholera  was  first  established  there  in  the  spring  of 
1818;  it  was  afterwards  observed  developing  itself 
in  several  tQwns  situated  upon  the  Doag  and  the 
western  bank  of  the  Jumna.  At  the  end  of  March  it 
suddenly  broke  out  in  the  city  and  district  of  Allaha- 
bad, and  there  reigned  several  months  with  great 
activity.  The  troops  stationed  in  the  forts  and  in 
the  town  were  not  attacked  until  the  middle  of  June 
following,  notwithstanding  they  had  very  free  com- 
munication daily  with  the  city. 

In  the  month  of  March  1818,  still  pursuing  the  di- 
rection from  east  to  west,  it  reached  Allahabab,  a  city 


100 

situated  at  the  confluence  of  the  Jumna  and  Ganges, 
where  it  maintained  itself  until  the  month  of  August ; 
from  thence  it  gained  Delhi,  Jagpour  and  a  camp 
composed  of  fifteen  thousand  natives  and  an  Eu- 
ropean company  of  artillery.  The  disease  bore 
hardest  upon  that  class  of  poor  who  had  not  even 
rice  to  eat;  however  the  Europeans,  who  were 
most  spared  by  the  Cholera-morbus,  perished  more 
from  intermittent  fevers,  which  reigned  simulta- 
neously. Animals  even  were  under  the  influence 
of  a  morbific  constitution  ;  many  camels  and  goats 
died  from  diarrhoea ;  and  a  great  mortality  wras  also 
observed  among  dogs  and  horned  cattle.  It  was 
even  supposed  by  the  Hindoos  that  the  roots  of  the 
bamboo  rotted  under  foot  and  gave  way,  when 
Cholera  appeared  in  their  neighbourhood. 

Whilst  ascending  the  course  of  the  rivers  which 
empty  into  the  Ganges,  the  disease  also  spread  over 
the  western  coast  of  Coromandel,  and  notwithstand- 
ing these  countries  were  but  thinly  inhabited,  it 
marched,  without  stopping,  from  the  north  to  the 
south.  In  the  month  of  October  1817  it  was  already 
observed  at  Neblore  ;  in  January  1818,  at  Madras; 
at  Pondicherry,  Carnate  and  Bellary,  in  the  month 
of  June.  It  was  not  until  January  1819  that  the 
epidemic  appeared  at  Freiwandroum  and  in  the  Isle 
of  Manaar,  notwithstanding  it  was  discovered  in  the 
island  of  Ceylon  so  early  as  the  year  1818.  Its 
invasion  was  always  sudden,  the  individuals  attacked 


101 

dying,  very  frequently,  in  the  space  of  two  or  three 
hours.  In  no  place,  says  Schnurrer,  could  its  ap- 
pearance be  referred  to  the  direct  communication 
of  one  individual  with  another.  Sometimes  it  leaped 
over  several  points  in  the  line  of  its  route,  in  order 
to  return  and  visit  with  the  greater  rigour  those 
place  which  it  had  at  first  spared.  Its  propagation 
does  not  seem  to  have  had  the  least  relation  with  the 
variations  of  temperature. 

At  the  commencement  of  the  same  year,  (1819,) 
that  the  Cholera-morbus  appeared  in  the  island  of 
Ceylon,  it  also  manifested  itself  more  towards  the 
east,  at  Aracan,  Malacca,  Sinkapour  and  the  island 
of  Sinang :  then  in  the  isle  of  Java,  where  it  re- 
appeared in  1821,  again  producing  much  evil.  In 
the  latter  island  the  disease-  evidently  manifested 
its  relation  with  volcanic  eruptions  ;  and,  on  the 
other  hand,  it  has  several  times  happened  that  the 
disease  has  been  suddenly  interrupted  in  its  pro- 
gress, in  consequence  of  explosions  of*  the  same 
nature.  At  Manilla,  the  epidemic  was  developed 
three  days  after  a  dreadful  hurricane,  and  must 
have  destroyed  an  enormous  number  of  victims. 

But,  the  more  we  advance  towards  the  east,  the 
more  uncertain  are  the  data,  on  account  of  the  few 
communications  which  we  have  had  with  this  almost 
uncivilized  countrv. 

Having  visited  the  Islands  Ternate,  Coelebes,  and 
Banda,  the  scourge  of  Cholera,  in  1823,  fell  heavily 

10* 


102 

upon  the  isle  of  Amboina.  At  Macassar,  the  dis- 
ease seldom  continued  longer  than  three  hours ;  there 
involving  in  its  work  of  destruction  apes,  dogs,  and 
horned  cattle.  Two  years  previously  an  earthquake 
had  been  felt  in  this  island. 

The  data  on  the  ravages  produced  by  the  disease, 
in  its  march  from  east  to  west,  are  a  little  more 
exact.  In  the  month  of  February  1821,  its  effects 
were  felt  at  Surat ;  then  upon  both  banks  of  the 
Indus,  and,  at  the  same  time,  at  Mascat,  Moultra, 
Bender-Abbas,  and  Bassora.  From  thence,  it  as- 
cended the  Euphrates  by  Helle,  and  towards  the 
end  of  August,  1821,  it  invaded  Bagdad,  where  it 
cut  off  30,000  individuals.  In  this  country  the  name 
of  haouwa  was  given  to  it,  which  signifies  tornado. 
The  Persian  army,  cantoned  between  Bagdad  and 
Kourdistan,  lost  more  than  2,000  men  ;  in  conse- 
quence of  which  catastrophe  the  Persians  were 
obliged  to  raise  the  siege  of  Ezzeroun,  to  conclude 
an  armistice  and  make  peace  with  the  Ottomans. 

It  was  in  the  month  of  June,  1822,  that  the  first 
patients  were  observed  in  Mossoul,  in  August  at 
Marden,  in  September  at  Diarbeckur,  in  October 
at  Orta,  and  in  November  almost  simultaneously  at 
Bir,  Aintab,  and  Aleppo:  in  all  these  places  there 
had  also  been  shocks  of  an  earthquake,  especially  at 
Aleppo.  On  the  10th  of  June,  1822,  the  epidemic 
made  its  appearance  in  the  vicinity  of  Laodicea,  and 


103 

on  the  20th  at  Antioch,  which  were  to  the  disease  the 
pillars  of  Hercules,  in  its  southwestern  direction. 
Often,  in  these  countries,  death  took  place  within 
two  hours  after  vomiting  had  commenced. 

Towards  the  close  of  August,  1821,  when  the 
disease  began  to  manifest  itself  at  Bagdad,  it  was 
productive  of  great  mortality  at  Schiraz,  where  a 
trembling  of  the  earth  had  likewise  been  expe- 
rienced. Departing  from  Schiraz,  the  Cholera- 
Morbus,  pursuing  its  way  towards  the  north,  ex- 
tended to  Zergoun  and  Mayin,  where  it  stopped  for 
this  year.  Jesd,  situated  farther  to  the  east,  was 
invaded  by  the  Cholera,  first  in  the  month  of  Sep- 
tember of  the  same  year,  continued  to  prevail  there 
throughout  the  month  of  October,  ceased  on  the 
arrival  of  cold  weather  in  November,  and  reappear- 
ed at  the  commencement  of  the  following  year, 
1822.  From  thence  the  disease  again  took  a  north- 
ernly  direction,  spreading  desolation  throughout  the 
cities  of  Nain,  Kashan,  Koom,  Kozbroun,  Sava, 
Dain,  Killat,  Nargan,  &c.  In  summer  it  reached 
Tauris,  without,  at  this  time,  penetrating  into 
Teheran. 

Let  us  dwell  for  a  moment  on  this  fact.  The  dis- 
ease reigned  in  the  west,  where  it  was  propagated  in 
various  directions.  The  city  of  Teheran  remained 
entirely  exempt  from  it.  The  Schah,  from  the  ad- 
vice of  Dr.  Martinengo,  interdicted  all  communica- 


104 

tion  between  this  city  and  the  environs;  he  especial- 
ly forbade  the  entrance  of  caravans  into  it.  The 
Cholera  had,  however,  mowed  down  one  third  of 
the  population  of  Bassora  and  of  Bagdad  ;  but  let 
us  also  add,  in  order  that  we  may  say  the  whole 
truth,  that  the  Cholera  made  pretty  extensive 
ravages  at  Teheran  in  the  year  1827. 

The  cold  weather  of  the  month  of  November  soon 
put  a  stop  to  the  march  of  the  epidemic ;  but  it  re- 
appeared the  year  after  in  the  month  of  March,  and 
pushed  its  way  even  to  the  frontiers  of  the  Russian 
empire.  In  the  month  of  May,  it  appeared  in  the 
province  of  Schirwan,  but  recently  ceded  to  Russia. 
On  the  17th  of  June  it  made  its  appearance  at  Len- 
koran, on  the  borders  of  the  Caspian  Sea,  in  the  isles 
situated  at  the  mouth  of  Kour ;  it  ascends  this 
river,  enters  the  vallies  and  gorges  of  the  moun- 
tains, and  arrives  at  Bakun,  a  city  whose  population 
comprizes  12,000  Persians  and  800  Russians. 

In  the  northern  direction,  the  epidemic  was 
traced  no  farther  than  Saharempore :  the  lofty 
chains  of  mountains,  which  in  other  places  merely 
retarded  the  march  of  the  Cholera,  here  seemed  to 
intercept  it  completely,  and  thus  preserved  the  in- 
habitants of  the  mountainous  districts. 

In  September  the  Cholera  reached  Astrakan, 
then  Krasnojar  ;  it  continued  a  month  in  the  former 
city,  and  only  fifteen  days  in  the  latter.    From  what 


105 

has  occurred  during  the  last  three  or  four  years  in 
Persia  and  Asia-Minor,  we  know  that,  in  the  coun- 
tries in  which  the  epidemic  appeared  for  the  first 
time,  its  appearance  usually  occurred  towards  the 
end  of  summer,  and  then  it  was  not  very  violent, 
but  so  soon  as  the  winter  had  passed,  its  intensity 
increased.  Now,  as  the  Cholera  did  not  reappear 
in  the  course  of  the  year  1824,  either  in  Syria  or 
along  the  borders  of  the  Caspian  Sea,  we  had  some 
foundation  for  believing  that  the  disease  attained 
its  natural  limits  at  Astrakan  and  Krasnodar.  Un- 
fortunately it  wras  not  so.  Having,  from  1824  to 
1827,  revisited  a  part  of  the  places  which  it  had 
ravaged  the  preceding  years,  such  as  Chakolly, 
Calcutta,  the  island  of  Java,  &c,  it  reigned  at  Pekin 
during  1821,  1822,  1823,  and  in  1826,  at  Koussou- 
Chaton,  a  city  situated  at  the  distance  of  100 
werstes  to  the  north  of  the  great  wall.  At  Chakolly 
a  little  before  the  invasion  of  the  Cholera,  a  conta- 
gious disease  prevailed  among  dogs,  which  destroyed 
13— 16ths  of  their  number. 

In  the  Phillippine  Islands  of  the  Indian  Ocean  the 
disease  made  its  appearance,  where  it  gave  rise  to 
some  facts  relative  to  its  propagation,  which  deserve 
to  be  noted. 

On  the  20th  September,  1829,  the  Tojmz,  an 
English  frigate,  sailed  from  Calcutta.  Its  equipage 
had   communicated  freely  with  the   countries  in 


106 

which  the  Cholera  existed,  and  with  their  inhabit- 
ants. Many  individuals  were  taken  sick  at  the  very 
commencement  of  the  voyage.  The  frigate  stopped 
at  Manilla,  and  then  sailed  to  Port-Louis  in  the  Isle 
of  France ;  the  Cholera,  which  reigned  on  board 
rapidly  extended  to  the  population  of  Port-Louis, 
where  in  six  weeks  it.  destroyed  six  thousand  men. 

In  connexion  with  this  fact,  it  is  essential  to 
remark,  that  the  disease  broke  out  suddenly  in 
different  quarters  of  the  town ;  that  several  negresses 
had  gone  on  board  the  vessel  on  the  very  day  of  its 
arrival ;  that  they  continued  to  remain  there  as  well 
as  frequent  it,  and  the  encampment  also  where  the 
equipage  was  established ;  yet  notwithstanding  none 
of  them  were  attacked  with  the  Cholera. 

The  disease  did  not  appear  more  promptly  nor 
more  violently  in  the  environs  of  the  encampment 
than  elsewhere,  and  the  physicians  have  stated  posi- 
tively that  it  attacked  a  great  number  of  individuals 
who  had  nothing  in  common  with  them  but  the  air 
which  they  breathed. 

Finally,  the  disease  attacked  almost  exclusively 
those  poor  individuals,  who  were  destitute  of  the 
common  comforts  and  even  necessaries  of  life,  and 
especially  those  whom  an  extenuation  of  misery  had 
reduced  to  an  almost  habitual  state  .of  disease. 

On  the  14th  of  August,  1817,  the  royal  frigate 
La  Cybele,  navigating  the   China  Sea,  put  in  at 


107 

Macao,  where  divers  refreshments  were  purchased 
for  the  equipage.  Again  setting  sail  on  the  18th, 
she  continued  her  course  up  the  strait,  when  on  the 
fourth  day  from  her  departure,  several  marines  ex- 
perienced the  symptoms,  and  there  the  disease 
ceased. 

It  was  on  the  22d  January,  1822,  says  our  col- 
league Keraudren,  in  his  interesting  work  on  the 
Cholera  of  India,  that  the  royal  frigate  La  Cleojyd- 
tre  cast  anchor  in  the  Manilla  road;  on  the  30th 
the  Cholera  first  made  its  appearance,  and  on  the 
following  days  the  number  of  men  attacked  mul- 
tiplied to  such  an  extent,  that  on  the  7th  proximo 
M.  le  Chevalier  Courson,  of  the  Ville-Helio,  com- 
mander of  the  frigate,  ordered  the  departure  for 
Macao.  The  number  of  patients  had  rapidly  increas- 
ed to  thirty-two,  seven  of  whom  died.  Eight  days 
after  the  departure,  there  were  no  more  new  cases. 

In  the  frigates  Cybele  and  Cleopatra,  M.  Kerau- 
dren justly  observes,  no  circumstance  was  present- 
ed which  permitted  the  supposition  that  the  Chol- 
era was  contagious.  It  must  not  be  forgotten,  he 
adds,  that  the  latter  vessel,  the  Cleopatra,  had  not  the 
disease  on  board  when  she  cast  anchor  at  Manilla, 
and  that  it  ceased  soon  after  her  departure. 

M.  Levincent,  in  his  inaugural  dissertation,  pre- 
sented to  the  faculty  of  Paris  in  July,  1829,  relates 
the  following  fact. 


108 

In  1826,  the  ship  Fils  de  France,  sailed  for  Nantz, 
having  had  no  patient  with  Cholera  on  board  whilst 
she  laid  at  anchor  in  the  Ganges.  Ten  days  after, 
in  consequence  of  undergoing  repairs,  she  was 
obliged  to  enter  one  of  the  basins  on  the  right 
bank,  which  it  became  necessary  to  empty  in  order 
to  expose  her  keel.  The  fermentation  occasioned 
by  the  sun,  in  the  muddy  bottom  of  the  basin,  gave 
rise  to  miasmata  ;  and  eighteen  hours  afterwards 
the  Cholera  indiscriminately  seized  the  men,  the 
most  vigorous  as  well  as  the  debilitated.  No 
change  however  had  taken  place  in  the  regimen  of 
the  equipage. 

This  fact  is  particularly  important,  in  as  much  as 
it  seems  rigorously  to  indicate  that  the  Cholera- 
morbus  maybe  spontaneously  developed,  in  a  vessel, 
under  the  influence  of  the  insalubrious  conditions 
adapted  to  their  origin. 

At  the  beginning  of  July,  1829,  the  disease  had 
penetrated  into  the  Russian  provinces  of  Shervan 
and  Bakou,  whence  it  spread,  following  the  great 
line  of  communication  by  land,  as  far  as  Tiflis,  and 
from  the  port  of  Bakou,  by  sea,  to  Astrakan. 

In  the  spring  of  the  year  1830,  news  was  re- 
ceived that  the  Cholera-Morbus  had  re-appeared 
in  Persia,  in  the  province  of  Chorazan,  from  whence 
it  passed  to  Tauris,  the  usual  residence  of  Abbas 
Mirza,   where   it   committed    great    ravages.     A 


109 

member  of  the  Russian  Legation  was  numbered 
with  the  victims,  and  Prince  Dolgorouki,  the  min- 
ister, after  a  very  serious  attack,  escaped  death  but 
with  difficulty. 

Before  proceeding  further,  let  us  point  out  in  a 
summary  manner,  the  principal  conditions  of  the 
extension  of  the  disease  in  India. 

In  many  circumstances,  the  epidemic  Cholera  of 
India  has  seemed  to  follow  pretty  exactly  the 
march  of  bodies  of  military  troops  ;  of  this  we  find 
several  instances  mentioned  in  the  documents  pub- 
lished by  the  health  officers  of  Calcutta,  Madras, 
and  Bombay. 

This  congregating  of  men,  fatigues,  privations, 
dangers,  and  the  excesses  inseparable  from  a  mili- 
tary life,  seem  peculiary  favourable  for  the  exten- 
sion of  this  scourge. 

In  1821,  as  we  have  already  seen,  the  Persian 
army,  cantoned  between  Bagdad  and  Kourdistan, 
lost  more  than  two  thousand  men  by  the  Cholera. 
This  fatal  circumstance  caused  the  raising  of  the 
siege  of  Erzeroum,  brought  about  an  armistice, 
and  shortly  after  led  to  the  declaration  of  peace 
between  the  Turks  and  Persians. 

We  almost  always  find  in  India  that  the  Chol- 
era is  developed  simultaneously  in  several  points, 
and  in  places  very  remote  from  one  another, 
leaving  a  great   number   of   intermediate  cantons 

11 


no 

in  a  state  of  perfect  salubrity.  It  is  thus,  for 
example,  that  the  Cholera  appeared  simultaneous- 
ly in  the  cities  of  Behar  and  Dacca,  which  are 
at  a  distance  of  one  hundred  and  twenty  leagues 
asunder.  It  is  also  thus  that  between  Nagpore 
and  Moltay,  which  the  disease  so  cruelly  afflicted, 
the  whole  of  the  intermediate  country  remained 
healthy  and  unmolested. 

Even  in  the  midst  of  a  vast  region,  suffering 
under  Cholera  in  all  its  malignancy,  we  find  cer- 
tain tracts,  considerable  spaces,  where  the  disease 
has  not  penetrated,  whilst  the  surrounding  country 
is  but  a  theatre  of  despair  and  destruction.  The 
Hill-Forts,  in  Kandiest,  says  Annesley,  remained 
exempt  from  the  Cholera,  whilst  the  disease  in- 
flicted the  greatest  ravages  on  all  the  surrounding 
places. 

The  individual  invasion  of  this  disease  is  so 
abrupt,  or,  in  other  terms,  the  space  which  inter- 
venes between  perfect  health  and  the  full  mani- 
festation of  the  Cholera  is  so  brief,  that  it  becomes 
impossible  to  trace  the  intermediate  changes,  such 
as  commonly  occur  in  diseases  transmissible  by 
absorption  ;  and  as  the  greater  number  of  patients 
have  been  seized  without  having  approached  any 
individual  labouring  under  Cholera,  it  would  seem 
that  the  epidemic  mode  of  accounting  for  its  oc- 
currence is  the   only   admissible    one,  especially 


Ill 

when  the  logic  of  the  facts  does  not  admit  of  any- 
other. 

The  sudden  and  simultaneous  appearance  of 
epidemic  Cholera  in  entire  districts  and  particular 
stations  ;  the  abrupt  violence  with  which  it  mani- 
fests itself;  the  great  number  of  individuals  at- 
tacked at  the  same  instant ;  the  fierce  and  rapid 
march  of  the  disease,  and  its  prompt  disappearance 
after  great  devastation  :  these  are  so  many  con- 
siderations which  seem  to  exclude  every  way  of 
transmission  except  the  epidermal. 

In  almost  every  part  of  India,  persons  attending 
upon  the  sick  have  been  seized  by  the  epidemic 
in  numbers  proportionately  less  than  other  indi- 
viduals :  persons  attacked  with  Cholera  when 
placed  in  large,  well-aired  and  very  clean  apart- 
ments, in  the  midst  of  patients  labouring  under 
different  diseases,  have  not  communicated  the 
Cholera  to  their  neighbours :  when  there  was  a 
Choleric  person  in  a  house  or  family,  the  other 
inhabitants  of  the  house,  or  members  of  the  family, 
were  not  more  exposed  to  contract  the  disease 
than  the  rest  of  the  population :  almost  always, 
when  there  were  several  patients  with  Cholera  in 
the  same  house,  they  were  attacked  in  such  a 
mode  of  succession,  in  a  manner  so  sudden  and  so 
independently  of  one  another,  that  it  was  not  pos- 
sible to  suppose  that  the  disease  had  passed  from 


112 

one  to  the  other :  finally,  when  several  indi- 
viduals have  been  successively  attacked,  it  has 
almost  always  been  evident  that  each  of  them  had 
been  exposed  to  the  same  productive  causes  of 
the  disease,  and  that  moreover  they  had  been  pre- 
pared to  contract  it  by  the  action  of  well-deter- 
mined pre-disposing  causes. 

Doctor  James  Jameson,  recording  secretary  of 
the  Medical  Council  of  Calcutta,  has  recorded  in 
his  report  the  following  fact. — Out  of  two  hundred 
and  fifty-three  physicians  who  have  attended  to 
the  disease  throughout  its  whole  course,  three  only 
were  attacked  by  it,  one  of  whom  died.  The 
latter  case  was  at  Barrachpour,  a  station  but  slightly 
visited  by  the  complaint.  The  other  two,  in  whom 
the  disease  was  not  very  severe,  reached  the  centre 
of  the  army  at  Nagpore.  The  medical  authorities 
visited  the  hospitals  both  night  and  day,  remaining 
there  for  a  considerable  time,  yet  none  of  its  mem- 
bers  were  seized  with  Cholera. 

Doctor  Annesley,  for  five  years  physician  to  the 
Madras  Medical  Establishment,  had  under  his  care 
a  continued  succession  of  patients,  the  average 
number  being  from  one  hundred  and  seven- 
ty to  two  hundred  per  day.  The  hospital  was 
kept  in  a  state  of  perfect  cleanliness  and  free  ven- 
tilation. All  the  wards  were  open  and  communi- 
cated constantly  with  one  another.     A  great  num- 


, 


113 

ber  of  individuals  attacked  with  Cholera  were 
brought  to  it  daily,  and,  notwithstanding  these 
persons  were  indiscriminately  dispersed  among  the 
other  patients  in  the  hospital,  Mr.  Annesley  has 
never  seen  more  than  from  six  to  seven  cases 
developed  in  the  house,  and  that  during  a  period  of 
five  years. 

The  disease  generally  attacks  those  who  are 
debilitated  by  forced  marches,  and  by  excesses  of 
every  kind ;  poor,  uncomfortably  lodged,  badly 
clothed,  and  improperly  nourished  individuals  ;  in 
a  word,  all  those  who  are  suffering  from  the 
depressing  effects  of  fear  and  sorrow,  from  ex- 
haustion consequent  upon  bodily  fatigue  or  dis- 
sipation, from  filth  and  the  privations  of  extreme 
poverty. 

Instead  of  increasing  daily  and  perpetuating 
itself  at  the  expense  of  the  additional  aliment 
which  it  constantly  finds  in  its  way,  the  disease 
has  invariably  followed,  in  the  places  which  it 
has  passed  through,  a  pretty  regular  course  of  in- 
vasion, increase,  maturity,  decline  and  extinction. 

Annesley,  in  the  epidemic  which  he  has  so  well 
described,  proves  that,  in  the  first  period  of  Chol- 
era, the  disease  is  rapid  and  generally  fatal ;  in 
the  second,  more  protracted  and  more  successfully 
treated  ;  and  at  a  still  later  period  comparatively 
mild,  of  short  duration  and  very  rarely  mortal. 

11* 


114 

In  1823,  Mr.  Dillon  calculated,  from  very  ac- 
curate tables,  that,  in  the  beginning  of  the  disease, 
there  were  nine  deaths  out  of  twenty-four,  and 
towards  the  decline  of  the  epidemic,  one  out  of 
fifteen :  in  the  most  favourable  times  of  the  in- 
termediate periods,  the  proportion  was  one  death 
out  of  seventeen  cases. 

From  the  official  reports  of  the  Presidency  of 
Madras,  in  1818,  similar  results  have  been  obtained, 
and  the  same  at  Bombay  and  Gaougoug. 

Considered  in  its  general  duration,  the  disease 
has  always  been  circumscribed  within  certain  limits; 
as  for  example,  three  weeks,  one  month,  two 
months,  and  seldom  more  than  three  months ;  the 
latter  period  has  been  rare  in  India,  and  this  dura- 
tion has  never  been  in  a  ratio  with  the  extent  of  the 
population. 

At  Husseinbad,  the  disease  declined  in  fifteen 
days.  In  Astia,  it  reigned  from  the  23d  of  April  to 
the  16th  of  May.  At  Vizianagram,  it  became  gen- 
eral in  the  beginning  of  July  and  declined  in  Decem- 
ber. At  Mazulipatam,  it  broke  out  on  the  20th  of 
July,  was  general  during  the  month  of  August,  de- 
clined in  September,  and  ceased  in  October  at  the 
moment  the  rainy  season  commenced.  The  ir- 
ruption of  1823,  in  Bombay  and  its  environs,  was 
of  three  months'  duration. 


115 

But  observations  of  this  kind  derived  from  mass- 
es of  regular  troops,  are  generally  more  com- 
plete and  entitled  to  a  much  greater  degree  of  con- 
fidence ;  for  here  the  facts  can  be  collected  more 
easily,  and  may  also  be  determined  with  greater 
accuracy. 

In  the  central  divisions  of  the  English  army,  the 
Cholera  appeared  on  the  7th  of  November :  from 
the  16th  to  the  22d  of  this  month,  it  was  at  its  high- 
est degree  of  intensity;  towards  its  close,  it  di- 
minished considerably,  and  about  the  2d  or  3d  of  De- 
cember it  had  completely  disappeared. 

In  the  division  of  the  left,  the  disease  began  on 
the  10th  of  April.  It  was  in  all  its  vigour  towards 
the  middle  of  the  month.  On  the  21st,  its  intensity 
was  diminished,  and  after  the  commencement  of  the 
month  of  May  there  was  not  a  case  to  be  seen. 

With  regard  to  the  Nagpoor  division  of  the  army, 
which  had  fallen  suddenly  into  a  malignant  jungle, 
{foyer  epidemique,)  it  was  different.  Here  the 
Cholera,  without  any  perceptible  distinction  of  its 
periods  of  invasion  and  increase,  immediately 
attained  its  acme.  Thus  the  disease,  which  com- 
menced on  the  31st  of  May,  had  already  diminished 
on  the  5th  of  June,  and,  on  the  18th,  had  almost 
totally  disappeared. 

Among  the  troops  of  Rajpoutana,  the  periods  of 
the  disease   were  still  more  rapid.     The  disease 


116 

appeared  on  the  14th  of  September ;  it  raged  with 
fury  until  the  20th,  and  then,  rapidly  diminishing,  it 
ceased  entirely  by  the  1st  of  Octoder. 

In  the  division  of  Hansi,  the  Cholera  began  its 
course  on  the  6th  of  August ;  it  increased  in  force 
during  some  days,  and  then,  gradually  declining, 
by  the  end  of  that  month  it  was  completely 
extinguished. 

When  more  or  less  considerable  military  detach- 
ments encamp  in  the  midst  of  these  epidemic 
jungles,  (foyers?)  or  even  when  they  merely  traverse 
them,  the  soldiers  almost  always  contract  the  Chol- 
era, and  that  in  an  intensity  proportioned  to  the 
action  of  the  general  predisposing  causes  under  the 
influence  of  which  they  are  found  placed  :  such  are 
anterior  fatigues,  bivouacs,  unwholesome  food, 
humidity,  soldier's  excesses,  &c.;  but  then  the  in- 
vasion of  the  disease  is  sudden,  simultaneous,  and 
general. 

We  read,  however,  of  many  instances  in  which 
bodies  of  soldiers,  being  assailed  by  the  disease, 
have  formed  a  junction  with  other  troops,  yet  the 
latter  remaining  in  health,  notwithstanding  such 
junction. 

On  the  morning  of  the  11th  of  May,  1817,  a  de- 
tachment of  the  first  battalion  26tji  regiment  of 
native  infantry,  consisting  of  ninety  men,  came  from 
a  lower  post  to  join  the  main  body  of  the  army 


117 

encamped  at  Sangar.  During  an  ordinary  march, 
the  detachment  in  perfect  health,  halted  half  way, 
selecting  as  a  place  of  shelter  the  borders  of  a  lake, 
situated  in  the  midst  of  an  open  plain,  and  about 
three  miles  in  circuit,  the  environs  interspersed  with 
trees,  and  agreeably  undulated.  All  these  men 
continued  well  even  at  nightfall ;  then  the  Cholera 
burst  forth.  The  first  patient  was  seized  at  mid- 
night :  he  died  in  half  an  hour ;  and  before  sunrise, 
twenty-four  men  out  of  the  ninety  were  taken  down 
with  the  disease.  Although  the  camp  of  Sangar 
was  only  five  or  six  miles  distant,  the  men  belonging 
to  the  detachment  were  too  weak  to  advance  with- 
out additional  assistance.  The  patients  were  trans- 
ported on  carts  and  litters  brought  from  Sangar: 
but  before  11  o'clock  in  the  morning,  when,  near 
the  close  of  their  journey,  five  were  already  dead,  and 
all  the  others  in  a  moribund  state.  The  next  morn- 
ing a  soldier  of  the  same  detachment  was  suddenly 
seized  whilst  brushing  his  clothes  ;  he  died  in  a  few 
minutes.  Several  others  fell  sick  on  the  three  fol- 
lowing days,  and  before  the  close  of  the  week  the 
whole  of  the  detachment  had  entered  the  hospital. 
Notwithstanding  these  men  were  indiscriminately 
mixed  with  the  troops  of  the  camp  of  Sangar,  not 
one  individual  among  the  latter  was  seized  with  the 
disease, 


118 

In  a  fort,  separated  from  the  city  of  Hutta  merely 
by  a  spacious  street,  there  were  a  number  of  Sea- 
poys  who  remained  in  a  state  of  perfect  health,  not- 
withstanding the  violence  of  the  Cholera  caused  a 
prompt  evacuation  of  this  city;  yet  the  fort  was 
small,  its  situation  less  salubrious  than  that  of  the 
city,  and  its  communications  with  it  unrestricted. 

At  Kotah,  where  several  hundred  persons  died 
daily,  the  citadel,  placed  under  the  influence  of 
similar  conditions,  was  in  like  manner  unmolested. 

The  islands  at  the  mouth  of  the  Ganges,  which 
lie  near  the  banks  where  the  Cholera-Morbus 
reigned,  were  not  invaded  by  it,  notwithstanding 
their  population  is  dense,  and  the  communication 
with  the  country,  ravaged  by  the  disease,  free  and 
uninterrupted. 

When  the  main  body  of  an  army  is  attacked  with 
Cholera  it  will  soon  be  released  from  it  by  separating 
and  dividing  into  several  detachments.  This  happy 
change  will  be  still  more  likely  to  happen,  if  the 
main  body  removes  to  a  better  station. 

From  the  6th  to  the  8th  of  November,  1817,  the 
disease,  which  had  gradually  approximated  the  en- 
campment occupied  by  the  central  division  on  the 
banks  of  the  Sind,  penetrated  into  this  portion  of 
the  army,  then  under  the  immediate  command  of 
the  Governor-General  Marquis  of  Hastings,  for- 
merly Lord  Moira.     It  first  attacked  the  Indians 


119 

employed  in  the  suite  of  the  troops,  but  soon  burst 
forth  every  where,  seizing  Europeans  as  well  as 
natives,  and  causing  death  in  the  space  of  a  few 
hours.  It  became  necessary  to  shift  the  encamp- 
ment. The  march  was  disastrous:  eight  thousand, 
or  at  least  one  tenth  of  the  regular  soldiers,  perished 
in  less  than  one  month.  On  the  2*2d  and  23d  of 
November,  soon  after  the  station  was  changed,  the 
disease  became  less  generally  prevalent.  On  the 
8th  of  the  following  month,  there  was  not  a  single 
case  of  Cholera  in  this  division  of  the  armv. 

Annesley  cites  many  examples  in  which  entire 
detachments,  quitting  a  station  where  the  disease 
reigned,  lost  in  their  route  a  certain  number  of  sick  : 
but,  when  once  arrived  at  the  new  station  they  in- 
tended joining,  having  no  longer  any  with  the 
Cholera  among  them,  neither  giving  rise  to  it  in 
those  with  whom  they  became  intermingled.  Among 
other  facts  recorded  in  his  work  we  find  the  follow- 
ing. The  Cholera  attacked  the  country  troops  sta- 
tioned at  Mallinghaum  in  Candeish  ;  it  reigned  with 
violence  over  the  soldiers  posted  on  the  left  of  the 
line.  The  seventeenth  battallion  of  infantrv,  on  the 
contrary,  which  occupied  the  right  of  this  line,  were 
entirely  exempt  from  it,  notwithstanding  it  main- 
tained a  constant  and  free  communication  with  the 
same  individuals.  This  seventeenth  battallion, 
which  preserved  such  a  satisfactory  state  of  health 
so  long  as   it  occupied  this  position,  suffered  much 


120 

in  its  turn  from  the  Cholera,  in  its  route  from  Mal- 
linghaum  to  Ellichapour,  where  it  was  to  rejoin  the 
army  under  the  command  of  Major-General  Sir 
John  Doveton. 

The  Physico-medical  Society  of  Calcutta,  in  its 
interesting  collection  of  memoirs,  similar  to  that  of 
our  ancient  Royal  Society  of  Medicine,  has  published 
a  considerable  number  of  partial  topographies  of 
India.  These  topographies,  detailed  by  physicians 
and  surgeons  of  the  English  army,  are  recom- 
mended by  the  extent  and  variety  of  information 
which  they  convey,  as  well  as  by  the  accuracy  of 
their  clinical  instruction.  In  these  memoirs  are 
exhibited  numerous  instances  of  local  insalubrity, 
which  it  is  difficult  to  avoid,  pervading  almost  every 
part  of  India,  and  also  the  great  extent  to  which 
bilious  intermittent,  and  remittent  fevers,  cholics, 
dysenteries,  &c,  &.,  prevail  in  this  country. 

But  on  the  other  hand,  we  perceive,  with  satis- 
faction, that  there  are  certain  descriptions  of  privi- 
leged places  where  conditions  most  conducive  to 
salubrity,  public  as  well  as  private,  abound :  there 
they  live  in  health  ;  there  convalescents  may  be 
securely  sent;  and  never  does  Cholera  occur  in 
these  situations.  Such  is  the  plateau  of  Neelgeries, 
which  the  estimable  author  of  this  topography  calls 
the  Montpelier  of  India  ;  such  also  is  Mount  St. 
Thomas. 


121 

It  seems  certain  that  the  winds  neither  hasten  nor 
retard  the  march  of  Cholera.  We  have  perceived 
the  disease  pass  from  Bengal  into  the  Deccan,  and 
forwards  from  Jaulna  towards  Punderpoor,  against 
the  southwest  wind,  which  constantly  blew  at  this 
time  during  several  months  in  succession. 

Neither  do  streams,  rivers,  lakes,  nor  arms  of  the 
sea,  oppose  the  extension  of  the  disease.  It  seems, 
on  the  contrary,  that  the  freshness  and  humidity  of 
the  atmosphere,  which  reign  upon  their  banks, 
favour  the  propagation  of  it.  The  Cholera  does 
not  absolutely  depend,  however,  on  the  influence  of 
humidity,  on  the  vicinity  of  seas,  lakes,  rivers,  and 
marshes,  since  places  totally  opposite  have  also 
been  subject  to  it.  It  has  ravaged  countries  situ- 
ated, as  Catamandou  in  the  Nepaul,  more  than  two 
hundred  leagues  from  the  shores  of  the  ocean,  coun- 
tries which,  like  Persia  and  the  Arabic  Peninsula, 
have  neither  rivers,  brooks,  nor  marshes. 

The  observations  of  the  physicians  of  Orenburg 
and  especially  those  of  Doctor  Lichtenstadt,  prove 
that  the.  epidemic  was  more  violent  and  severe  in 
close  weather,  on  moist  and  warm  or  moist  and 
cold  days,  than  when  the  days  were  dry  and  warm  ; 
during  dry  and  cold  weather  especially,  few  new 
cases  supervened. 

Certain  pretty  well  attested  facts  seem  to  prove 
that  the  Cholera  is  scarcely   ever  established  on 

12 


122 

elevated  plateaux  or  mountains.  It  has  not  been 
observed,  says  Schnurrer,  at  six  thousand  feet  above 
the  level  of  the  sea.  At  Tauris,  the  inhabitants 
attacked  by  the  disease,  retire  to  the  mountains, 
and  thus  escape  its  fury.  Dr.  Hasper,  on  the  other 
hand,  affirms  that  he  has  sometimes  seen  the  Cholera 
in  elevated  countries,  upon  the  mountains,  at  Nepaul 
for  instance,  which  is  more  than  four  thousand  feet 
higher  than  the  ocean  ;  at  Jabolpour,  on  the  south- 
erly aspect  of  the  mountains  of  Rewath  ;  on  the 
highest  plateau  of  the  Isle  of  France,  upon  the  peaks 
of  Tartary,  in  the  midst  of  the  sandy  deserts  of 
Arabia,  and  in  the  desert  Diabekir. 

In  the  month  of  June,  1818,  the  Cholera  made  its 
appearance  upon  the  lofty  mountains  which  separate 
Hindostan  from  Nepaul,  and  it  was  also  observed 
in  the  vallevs  of  Catamandou.  Padthum,  and  Bhat- 
youn,  the  elevation  of  which  is  more  than  four 
thousand  feet  above  the  level  of  the  sea ;  and  it 
even  appeared  upon  the  high  peaks  of  the  neigh- 
bouring districts  of  Himmalah.  Doctor  Gowan,  how- 
ever, who  described  the  latter  irruption,  in  a  memoir 
communicated  to  the  Medical  Society  of  Calcutta, 
is  fully  confident  that  the  disease  never  appeared  at 
a  greater  height  than  six  thousand  five  hundred  feet 
above  the  level  of  the  ocean.  Even  until  the  pres- 
ent, at  least,  the  mountains  of  Nilgherry,  which 
limit  Mysore  in  the  centre  of  the  Indian  peninsula, 


123 

have  been  exempt  from  the  Cholera  which  ravages 
at  their  foot  the  plain  of  Counbature.  These  moun- 
tains have  an  elevation  of  eight  thousand  seven 
hundred  feet  above  the  ocean,  and  the  habitations 
extend  to  at  least  five  thousand  feet. 

The  Cholera  has  been  observed  in  India  at  all 
seasons.  During  the  winter  of  1818,  it  reigned  with 
violence  at  Bombay.  There,  however,  it  has  been 
noted,  that  the  disease  usually  becomes  milder,  or 
even  ceases  entirely,  at  the  approach  of  the  winter 
season,  in  order  to  re-appear  in  the  following 
summer. 

In  India,  the  Cholera  attacks  men  more  frequent- 
Jy  than  women  and  children.  Schnurrer  positively 
asserts  that  women  and  children  seem  to  be  alto- 
gether exempt  from  it. 

On  several  occasions,  it  has  been  observed  that 
the  epidemic  ceases  suddenly  after  the  occurrence 
of  violent  storms  accompanied  with  thunder.  Doc- 
tor Christie  noticed  a  striking  example  of  the  kind 
at  Kulladzv,  in  1824. 

The  invasion  of  the  disease  generally  takes  place 
during  the  night  and  towards  morning. 

The  commencement  of  the  disease  has,  in  the 
opinion  of  almost  all  practitioners,  its  prodromes, 
symptoms  characteristic  of  the  period  of  imminence, 
which  we  have  previously  exhibited.  Well,  the  more 
intense  and  extensive  the  epidemic,  the  sooner  do 


124 

these  premonitory  symptoms  diminish,  become  less 
evident,  and  disappear. 

In  several  places,  a  little  before  or  at  the  moment 
of  invasion  of  the  epidemic,  it  has  been  noticed  that 
different  animals,  dogs  especially,  have  been  attacked 
by  various,  severe,  and  mortal  diseases. 

In  India,  cases  of  relapse  have  not  been  unfre- 
quent :  few  observers  are  there  who  have  not  cited 
examples  of  it :  Annesley,  Jameson,  Searle,  and 
Christie,  consider  it  a  very  common  occurrence. 

Long  after  the  cure,  says  Dr.  Jameson,  the  stom- 
ach and  intestines  remain  in  an  almost  hopeless 
state  of  debility,  and  the  frequent  appearance  of 
dysentery,  or  an  obstinate  diarrhoea,  attest  the  great 
ravages  produced  by  the  Cholera  on  the  constitu- 
tion :  in  these  cases  the  greatest  attention  must  be 
paid,  for  some  time,  in  order  to  prevent  a  complete 
relapse. 

One  important  fact,  and  which  has  been  pretty 
generally  observed,  is  the  following : — Every  person 
living  within  the  sphere  of  the  epidemic  region, 
who  escaped  the  Cholera,  experienced  nevertheless, 
though  in  different  degrees,  the  disagreeable  influ- 
ence of  the  epidemic.  This  influence  was  betrayed, 
in  the  invaded  populations,  by  great  uneasiness,  fre- 
quent vertigo,  sinkings  carried  even  to  syncope, 
pains  in  the  stomach,  constipation,  borborygmi, 
anorexia?,  loss  of  appetite,  gentle  diarrhoea;  in  short, 


125 

by  an  universal  disturbance  of  the  intestinal  func- 
tions. It  was  also  almost  universally  indicated  by 
those  spontaneous  lassitudes,  that  exhaustion  of  the 
muscular  powers,  which  so  frequently  denote  the 
imminence  of  grave  maladies,  those  especially  which 
appertain  to  nervous  fevers  and  typhoid  diseases, 
rather  than  those  of  an  inflammatory  nature. 


12* 


\ 


PART  SEVENTH. 


GEOGRAPHICAL  MARCH  AND  MODE  OF  THE  EX- 
TENSION OF  THE  DISEASE  IN  EUROPE. 

Let  us  now  follow  the  geographical  march  of 
the  disease,  at  that  so  highly  important  epoch,  when 
crossing  the  Ural  mountains,  which  separate  Asia 
from  Europe,  the  Cholera,  without,  as  it  seems, 
abandoning  Asia,  penetrated  into  Europe,  first  at- 
tacking those  governments  in  the  empire  of  Russia 
embraced  in  the  same  latitudes,  and  afterwards 
advancing  upon  us  in  the  two-fold  direction  from 
the  east  to  the  west,  and  from  north  to  south. 

Let  us  inquire  whether,  under  the  influence  of 
these  climates,  in  which  the  epidemic  Cholera  had 
been  hitherto  unknown,  the  disease  has  lost  or 
gained  any  thing,  and  also  endeavour  to  ascertain 
whether  any  additional  information,  relative  to  its 
propagation,  has  been  given  by  those  physicians 
who  have  studied  the  subject  in  these  countries. 

The  first  appearance  of  the  disease  was  in  the 
city  of  Orenburg,  in  the  military  hospital ;  at 
which  place,  about  seven  o'clock  in  the  morning 
of  the  26th  of  August,  1829,  the  first  case  of  Choi- 


127 

era  was  signalized.  This  fact,  surprising  in  its 
nature,  has  been  as  positively  established  as  com- 
ports with  the  bounds  of  possibility. 

In  the  first  place,  however,  let  us  cursorily  notice 
the  principal  data  relative  to  the  topography  of  the 
country. 

The  city  of  Orenburg,  lying  in  the  51  °  of  north 
latitude,  and  72°  of  east  longitude,  is  situated  be- 
tween the  two  chains  of  the  Ural  range,  in  a  spa- 
cious, open  valley,  destitute  of  wood,  and  extending 
in  a  direction  from  north-east  to  south-west.  The 
valley  is  watered  by  two  rivers,  one  small,  the  Sak- 
mare,  and  the  other  more  considerable,  the  Ural. 
It  is  a  little  above  the  confluence  of  the  two  rivers, 
and  on  the  right  bank  of  the  Ural  that  the  city 
presents  its  picturesque  appearance.  The  soil  on 
which  it  stands  is  equally  sandy  and  argillaceous, 
but  habitually  dry.  The  city,  surrounded  by  walls 
and  bastions,  and  having  four  large  gates,  is  inter- 
sected by  a  sufficient  number  of  streets  of  con- 
siderable width  and  running  in  a  straight  direction. 
The  houses,  for  the  most  part  of  wood,  are  over- 
laid with  stucco  both  within  and  without ;  the 
habitations  of  the  poor,  altogether  of  wood,  are 
C0Lt\Xi  with  clay. 

The  city  has  two  suburbs,  one  on  the  north-east, 
called  Cossack,  the  other  on  the  south-west,  named 
Slobodka.     In  these  the  houses  are  constructed  of 


128 

a  light,  porous,  moist  wood,  which  is  almost  always 
in  a  half  rotten  condition.  The  entire  population  is 
about  11,000  inhabitants,  of  which  number  six 
thousand  are  soldiers.* 

Provisions,  consisting  of  bread,  cheese,  full-grown 
meats,  mutton  especially,  of  fish,  vegetables,  and 
fruits,  are  wholesome,  abundant,  easily  obtained, 
and  very  cheap.  Mutton,  for  instance,  is  there 
sold  at  50  cops  the  poud,f  that  is  to  say,  90  cents 
for  40  pounds,  or  about  two  cents  the  pound  of 
this  country. 

The  inhabitants  generally  drink  the  waters  of 
the  Ural,  which  is  clear  and  of  good  quality. 

It  should  be  mentioned,  however,  that  epizooties, 
or  epidemics  among  cattle,  are  annual  in  this 
country,  by  which  a  prodigious  number  of  them 
are  destroyed. 

We  may  also  state,  both  with  regard  to  the 
physical  and  moral  constitution,  that  the  inhabitants 
generally  have  but  few  wants,  and  that  asthenic 
diseases  are  very  prevalent  among  them. 

The  peasants,  for  the  most  part,  are  principally 
dispersed  in  the  steppes,  where  they  are  almost 
exclusively  occupied  in  agriculture. 


*  According  to  Malte-Brun,  the  number  of  houses  is  2S66, 
and  the  population  20,000.— Tr. 

f  The  poud  is  equal  to  40  pounds. — Tr. 


129 

Finally,  notwithstanding  the  insalubrious  con- 
struction of  the  houses  in  the  suburbs,  the  city 
and  its  environs  possess  in  sufficient  degrees  the 
known  conditions  of  a  great  salubrity. 

Behold  then  the  Cholera  primarily  established 
in  a  city  which  scarcely  presented  any  general 
cause  of  insalubrity.  It  is  true,  that  the  season, 
immediately  preceding  that  in  which  the  epidemic 
appeared,  had  been  irregular,  -inconstant,  and 
marked  by  great  atmospheric  vicissitudes ;  the 
humidity  especially  had  been  great  and  sudden,  suc- 
ceeding  prolonged    heats   and   extreme    drought. 

It  is  also  true,  that  a  considerable  quantity  of 
fruits  of  an  indifferent  or  bad  quality  had  been 
gathered  in  this  year,  and  the  inhabitants  had  freely 
eaten  of  unripe  water  melons  and  cucumbers. 

It  is  also  true  that  the  koumiss,  a  species  of  drink 
made  from  fermented  mare's  milk,  had  failed,  and 
still  more  the  knout,  an  analogous  but  better  drink 
made  from  the  milk  of  the  sheep  and  the  cow. 

But  already,  in  antecedent  years,  had  all  these 
anti-hygienic  conditions  been  frequently  presented, 
in  the  same  degree,  and  in  similar  combinations, 
yet  without  the  least  appearance  of  epidemic 
Cholera. 

Let  us  further  add  with  respect  to  fruits,  that 
subsequently  to  their  absolute  interdiction,  and 
notwithstanding  the    rigid   measures    adopted   by 


130 

the  public  authorities  to  effect  their  total  exclusion 
from  the  city,  the  disease  increased  with  greater 
activity  and  counted  a  greater  number  of  victims. 

The  Cholera  having  appeared  then  at  Orenburg 
notwithstanding  the  salubrity  of  this  city,  it  be- 
came necessary  to  seek  elsewhere  for  its  origin ; 
the  epidemic  reason  not  being  as  yet  presented  to 
meditative  minds,  or  rather  this  reason  alone  was 
not  deemed  satisfactory. 

It  is  in  this  state  of  the  question  that  the  origin 
of  the  disease  has  been  attributed  to  an  importa- 
tion imputed,  by  some,  to  the  caravans  arrived  from 
Boukaria  and  Khiva,  and  by  others,  to  the  com- 
mercial relations  established  with  the  neighbouring 
hordes  of  Kirguis-Cossacks. 

The  Kirguis,  a  wandering  and  half-savage  peo- 
ple, encamped  in  the  immense  steppes,  beyond  the 
Ural  mountains,  being  in  constant  commercial  inter- 
course with  Turkestan,  Boukaria,  and  Khiva,  have 
long  been  in  the  habit  of  furnishing  Orenburg  with 
sheep,  felt,  camlets,  &c.  JNow,  when  the  Cholera 
appeared  at  Orenburg,  we  know  that  the  epidemic 
was  extending  its  ravages  in  Chorazan,  in  Asia 
and  Persia. 

Let  us,  however,  examine  both  assertions,  that 
is  to  say,  the  importation  of  the  Cholera  by  cara- 
vans and  by  the  Kirguis. 

On  the  26th  of  August,  1829,  at  nine  in  the  morn- 


131 

ing,  surgeon-major  Smirnorff  detected  the  Cholera- 
Morbus  in  Andre  Yvanoff,  a  soldier  of  the  3d 
batallion  of  the  line  then  in  garrison  at  Orenburg, 
who  was  carried  to  the  military  hospital  at  Oren- 
burg, where  he  died  at  about  the  expiration  of 
twelve  hours  from  the  commencement  of  the 
disease. 

From  the  26th  of  August  to  the  9th  of  Septem- 
ber, no  other  person  in  Orenburg  was  attacked 
with  the  Cholera. 

On  the  9th  of  September,  at  11  o'clock  in  the 
night,  another  soldier,  of  the  same  batallion  of  the 
line,  likewise  attacked  with  this  malady,  was 
brought  to  the  military  hospital.  He  died  towards 
five  o'clock  in  the  evening  of  the  following  day. 

The  day  after,  September  10th,  two  other  pa- 
tients were  sent  to  the  hospital,  one  of  whom  died, 
the  other  was  cured.  In  both  these  cases  the  dis- 
ease had  progressed  with  less  rapidity  than  in  the 
two  preceding. 

On  the  11th,  a  soldier  of  the  same  batallion  was 
attacked  and  carried  to  the  hospital ;  then  on  the 
14th,  a  soldier  of  the  batallion  of  invalids ;  again, 
on  the  16th,  two  other  soldiers  of  the  same  batal- 
lion, and,  finally,  on  the  17th,  two  non-commissioned 
officers. 

During  the  whole  of  this  time,  and  until  the  18th 
of  September,  only  two  individuals  among  the  citi- 


132 

zens  of  Orenburg  had  been  seized  with  the  mala- 
dy ;  both  of  whom  died.  One  was  an  excise 
officer,  the  other  a  tradesman. 

The  commerce  of  Orenburg,  a  city  altogether 
commercial,  has  for  a  long  time  been  maintained  in 
frequent,  extensive,  and  important  relations  with 
Asia,  India,  and  Persia:  it  is  at  least  since  1813 
that  the  city  of  Orenburg  has  been  in  the  habit 
of  admitting  annually  the  caravans  coming  from 
Kiachta  and  Boukaria :  now,  the  Cholera  reigned 
epidemically  in  these  countries  during  the  month  of 
August,  1817,  and  it  was  not  until  August,  1829, 
that  it  first  made  its  appearance  at  Orenburg. 

The  caravans  from  Boukaria  and  Khiva  arrived 
in  July  (the  20th  at  the  latest)  at  Orenburg,  were 
admitted  into  the  Court  for  Strangers,  after  sani- 
tary visits  and  inspection,  but  the  Cholera  was  not 
manifested  until  the  2Gth  of  August. 

Convoys  making  a  part  of  these  caravans,  had 
entered  about  the  same  time  into  the  fortresses  of 
Orstia  and  Troitzka,  yet  the  Cholera  did  not  appear 
in  these  two  fortresses. 

The  guards  and  camel-drivers,  hired  by  these 
caravans  in  one  place  and  in  another  throughout 
their  route,  have  entirely  escaped  the  disease. 

It  must  also  be  noted  that  these  Asiatic  traders 
loaded  and  unloaded  their  camels  during  their 
journey ;  that  whenever  they  arrived  at  an  aoula 


133 

or  encampment  of  Kirguis,  they  made  numerous 
exchanges  of  merchandize  for  provisions  of  every 
sort,  which  consequently  rendered  it  necessary  to 
unpack  the  bales  in  which  they  were  contained  : 
yet,  notwithstanding  these  different  operations,  there 
has  not  been  a  single  instance  in  which  Cholera 
was  communicated. 

From  the  26th  of  August,  the  day  in  which  the 
first  patient,  the  soldier  Yvanoff,  was  attacked  by 
the  disease,  and  who  died  with  it  on  the  same  day, 
until  the  9th  of  September,  there  was  not  a  single 
individual  seized  with  the  Cholera  at  Orenburg. 

The  Cholera  suddenly  makes  its  appearance 
among  the  poorer  class  of  people,  in  individuals 
worn  down  by  hard  labour  and  debilitated  by  ex- 
treme want.  It  wTas  not  first  observed  among  cus- 
tom-house officers,  in  continual  communication  with 
the  suspected  Kirguis  and  in  constant  contact  with 
the  suspected  articles  of  merchandize.  It  has  not 
attacked  the  merchants  who  purchased  camlets, 
felts,  and  furs ;  it  has  respected  easy  or  rich 
people  who  carried  them.  The  traffic-market 
of  Orenburg,  situated  at  the  distance  of  three 
versts*  from  the   city,  on   the  right  bank   of   the 


*  About  two  miles  ;  a  verst  being  nearly  two  thirds  of  an  Eng- 
lish mile. — Tr. 

13 


134 

Ural,  where,  during  the  whole  summer  and  one 
half  of  the  autumn,  the  Russian  and  Asiatic 
merchants  reside  and  exchange  their  merchandize 
with  that  of  the  Kirguis,  it  would  seem  ought  to 
have  been  the  first  theatre  on  which  the  disease 
appeared  ;  yet,  notwithstanding,  it  was  in  a  lesser 
proportion  and  at  a  later  period  that  these  quarters 
were  attacked. 

The  Cholera  had  existed  a  long  time  in  the  city 
of  Orenburg,  when  it  broke  out  in  the  badly  con- 
structed fauxbourgs  which  constitute  the  boundaries 
of  it. 

Now  it  was  not  until  the  28th  of  September  that 
information  was  received  of  the  first  appearance  of 
the  Cholera  in  the  environs  of  Orenburg ;  and, 
surprising  circumstance  !  whilst  the  villages  nearest 
to  the  city,  having  intimate  relations  and  constant 
communication  with  it,  were  altogether  exempt 
from  the  Cholera;  whilst  the  fortresses  adjacent  to 
Orenburg  and  situated  in  the  line  of  the  two  prin- 
cipal roads  which  terminate  at  this  place,  preserved 
their  habitual  salubrity, — during  this  time,  the  Chol- 
era exhibited  its  accustomed  ravages  in  villages 
at  some  distance  from  Orenburg,  and  also  in  a 
fortress  situated  at  more  than  a  hundred  versts  from 
this  city,  which  had  maintained  but  very  little  com- 
munication with  it. 

The  villages  lying  east  from  Orenburg,  between 


135 

the  Ural  mountains  and  the  city,  but  beyond  the 
latter,  in  the  line  of  communication  of  Asia  with 
Orenburg;  these  villages,  Nieginka  and  Kaminoe 
for  instance,  although  built  along  the  upper  Ural 
and  having  free  intercourse  every  hour,  as  well  as 
every  day,  with  the  city,  have  not  been  invaded  by 
the  malady. 

In  the  military  hospital  of  Orenburg,  the  Cholera 
began  on  the  26th  of  August,  and  did  not  cease  its 
reign  until  the  20th  of  November ;  the  number  of 
persons  attacked  with  the  disease  was  two  hun- 
dred and  ninety-nine,  of  which  number  two  hun- 
dred and  twenty  were  cured  and  seventy-nine 
died  :  we  have  stated  above  that  the  garrison  con- 
sisted of  six  thousand  men. 

In  the  city  of  Orenburg,  the  disease  did  not 
commence  until  the  15th  of  September ;  and  on 
the  20th  of  November  there  was  not,  either  in 
the  city,  or  its  suburbs,  a  single  patient  with  the 
Cholera.  Of  the  entire  population  of  the  city  and 
its  fauxbourgs,  which  is  estimated  at  seven  thousand, 
there  were  eight  hundred  and  one  patients,  out  of 
which  number  six  hundred  and  eighty  were  cured 
and  one  hundred  and  one  died. 

Immediately  after  the  city  of  Orenburg,  the  first 
two  villages  attacked  by  the  epidemic  were  the  burgh 
of  Rassipnoe  and  the  village  of  Bicoulovoy,  placed 
at  a  great  distance  from  one  another,  upon  two 


136 

diverging  routes,  having  intermediate  to  them 
a  great  number  of  other  towns  and  villages  which 
were  not  attacked  at  all  or  not  until  a  later  period, 
and  also  having  much  less  communication  with  one 
another  than  each  of  them  had  with  certain  other 
places  until  then  remaining  unmolested  by  the 
disease. 

The  village  of  Bicoulovoy  wTas  attacked  on  the 
28th  of  September ;  on  the  25th  of  October  it  was 
exempt  from  the  disease :  there  were  in  all  sixty- 
one  patients,  of  which  number  thirty-two  recovered 
and  twenty-nine  died. 

At  Samarsky,  the  Cholera  appeared  on  the  19th 
of  October,  and  ceased  on  the  27th  of  November. 

At  Bardskoy-Stanitzka,  it  broke  out  on  the  30th 
of  September,  and  it  was  not  until  the  13th  of  No- 
vember that  no  more  new  cases  were  observed. 

The  town  of  Rassipnoe  experienced  the  first 
assaults  of  the  Cholera  on  the  23d  of  September ; 
the  disease  did  not  cease  until  the  24th  of  October. 
Out  of  a  total  number  of  305  patients,  they  count 
nineteen  deaths  and  two  hundred  and  eighty-six 
cures. 

But,  let  us  extend  the  details  of  the  invasion  of 
the  disease  still  farther.  All  accounts  agree  in 
imputing  the  developement  of  the  disease  to  a  wine- 
dealer  who  had  gone  on  business  to  Orenburg,  and 


137 

who,  returning  sick  to  the  village,  died  of  Cholera 
on  the  day  following. 

Now  let  us  attend  to  the  clear  and  exact  account 
of  this  fact,  as  related  by  M.  Schoumoff,  chief  phy- 
sician to  the  brigade  of  Cossack  horse-artillery 
stationed  at  Orenburg  ;  let  us  transcribe  the  docu- 
ment. 

1st.  All  those  who  were  exposed  to  an  immedi- 
ate contact  with  the  wine-dealer,  during  his  illness 
and  after  his  death,  are  entirely  healthy,  and  not 
one,  without  exception,  has  been  attacked  with 
cholera. 

2d.  The  wine-dealer  fell  sick  on  the  19th  of  Sep- 
tember and  died  on  the  20th ;  on  the  20th  and  22d 
there  were  no  persons  attacked  by  the  disease.  On 
the  evening  of  the  23d  there  was  but  one  individual, 
who  had  been  suffering  a  long  time  from  diarrhoea, 
and  who,  in  addition,  was  intoxicated :  he  died  in 
the  space  of  twenty  hours.  On  the  25th,  in  the  af- 
ternoon, another  individual  was  taken  sick.  On  the 
27th  there  were  three  new  cases,  and  so  on.  I  pos- 
itively affirm  that  between  the  patients  and  those 
wrho  had  attended  upon  the  wine-dealer,  there  had 
not  been  the  least  communication. 

But  for  what  reasons  has  M.  Schoumoff  been  in- 
duced to  emit  this  last,  so  positive,  assertion ;  and 
how  is  it  possible  that  he  could  prove  it  ? 

HowTever,  it  is  certain  that  the  cholera,  in  a  pret- 

13* 


138 

ty  great  number  of  cases,  does  not  exclusively  at- 
tack several  individuals  at  once,  as  has  been  ad- 
vanced by  those  physicians  who  have  observed  the 
disease  in  India.  In  Russia,  it  has  frequently  been 
noticed  that  individuals  were  seized  successively, 
one  after  the  other ;  and  as  to  the  secondary  propa- 
gation of  the  disease  by  the  air  respired  by  the  sick, 
certain  facts,  collected  in  Russia,  prove  that  this 
mode  of  transmission  has  thus  taken  place  under 
circumstances  in  which  the  patient  inhabited  a  con- 
fined, ill-ventilated  locality,  or  when  the  attendants, 
relatives  and  friends,  pressed  for  too  long  a  time,  and 
in  too  great  numbers,  around  the  patient. 

In  every  point  of  view,  it  is  remarked  that  the  dis- 
ease has  been  less  severe  in  villages  than  in  the  in- 
terior of  hospitals.  Does  not  this  fact,  which  is 
generally  admitted,  seem  to  call  for  the  measure, 
so  propitious  in  other  epidemics,  of  encamping  and 
placing  in  barracks  in  appropriate  locations  those 
who  are  attacked  with  the  cholera.  It  is  especial- 
ly in  the  epidemic,  now  under  consideration,  that 
this  wise  measure  would  be  happily  applicable. 

Relatively  to  this  mode  of  propagation,  the  air 
exhaled  by  patients,  which  seems  to  be  establish- 
ed in  Russia  by  a  considerable  number  of  facts, 
whilst  in  India  there  is  not  the  least  cause  for  pre- 
suming it,  we  will  also  say  that,  in  these  warm 
climates,  they  have  no  need  of  sealing  up  the  cham- 


139 

bers  of  patients,  who,  on  the  other  hand,  find  them- 
selves as  if  naturally  encamped  or  barricadoed  in 
their  own  dwellings.  Without  taking  into  the  ac- 
count that,  in  these  countries,  the  crowding  together 
of  patients  and  great  accumulation  of  individuals, 
but  rarely  happens,  because  the  population  is  not 
sufficiently  dense  to  admit  of  it. 

The  district  of  Caen,  from  the  first  indications  of 
the  disease  in  the  government  of  Orenburg,  adopted 
the  most  particular  and  severe  precautions  against 
its  propagation.  Punishment  of  death  was  pro- 
nounced against  every  infraction  of  the  sanatory 
laws ;  yet  this  district,  notwithstanding,  has  been 
ravaged  by  the  disease. 

By  the  attention  and  vigilance  of  Boards  of  health 
measures  of  strict  medical  police  have  been  taken 
since  the  first  appearance  of  the  cholera  at  Oren- 
burg ;  these  measures  have  been  successively  ex- 
tended to  the  cities  and  surrounding  villages,  even 
to  Moscow,  without  having  the  least  effect  in  cir- 
cumscribing the  scourge.  The  disease  burst  out  at 
Moscow  in  October  1830. 

The  disease,  restricted  at  first  to  the  interior  of 
Russia  and  of  Poland,  proceeds  onwards  to  the 
the  coasts  of  the  Baltic,  and  almost  all  the  ports  of 
this  sea  become  infected  by  it.  In  Riga,  on  the 
12th  of  June,  there  were  two  thousand  five  hundred 
and  forty-one  patients,  of  which  number  twelve 


140 

hundred  and  two  perished.  On  the  26th  of  May 
the  cholera  was  observed  at  Dantzig. 

Towards  the  south,  this  dreadful  scourge  seems  to 
have  been  equally  progressive.  Kioff,  the  Ukraine, 
Podolia,  Volhinia,  and  Moldavia,  in  all  these  prov- 
inces the  victims  were  numerous  and  in  rapid  suc- 
cession, especially  among  the  Jew  population  who 
were  there  plunged  in  the  most  profound  ignorance, 
and  consequently  reduced  to  extreme  poverty.  At 
Brody,  where  out  of  thirty -five  thousand  inhabitants 
twenty-four  thousand  are  Jews,  there  were,  on  the 
9th  of  June,  eight  hundred  deaths  out  of  seventeen 
hundred  patients.  Gallacia  and  especially  Limberg, 
Silesia,  and  particularly  Olmutz,  have  not  been 
spared. 

Astrakan,  a  very  commercial  city,  the  population 
of  which  amounts  to  thirty  thousand  inhabitants, 
was  visited  by  the  Cholera  in  1823.  The  disease 
reigned  scarcely  six  weeks.  The  number  of  sick 
did  not  exceed  two  hundred  and  sixteen,  yet  the 
deaths  were  in  the  dreadful  proportion  of  one  in 
three.  From  this  moment  Russia  adopted  the  most 
extensive  and  vigilant  sanatory  measures,  in  order 
to  prevent  the  extension  of  the  disease  into  the 
southern  districts  of  the  Russian  Empire.  Every 
body  knows  the  result  of  these  measures  ! 

How  great  are  the  precautions  which  the  public 
administration  has  taken  at  Moscow  !    Even  when 


141 

the  order  was  given  by  the  Emperor  for  raising 
the  cordon  which  surrounded  the  city,  every  pos- 
sible means  was  used  to  hinder  the  disease  from  re- 
appearing, and  for  preventing  its  importation  in- 
to those  places  with  which  communication  had 
been  re-established.  Houses  suspected  of  infection 
continued  to  be  sequestered  ;  barriers  of  observa- 
tion were  maintained,  and  military  cordons  estab- 
lished, together  with  quarantines  on  the  frontiers 
of  the  government  of  Moscow.  As  for  the  rest,  it 
is  well  known. 

Petersburgh,  although  eighty  leagues  distant  from 
the  nearest  point  where  the  disease  had  made  its 
appearance,  was  also  subjected  to  the  most  rigid 
preventive  measures  ;  a  triple  cordon  guarded  the 
communications  ;  extraordinary  hospitals  were 
there  established,  and  the  government  prescribed 
to  the  inhabitants  the  laying  in  of  a  year's  provis- 
ions. Petersburgh  has  been  twice  visited  by  the 
epidemic. 

And  on  the  other  hand,  in  Thorn,  the  Cholera 
has- not  been  observed,  or  at  least  it  did  not  appear 
in  this  place  until  a  much  later  period  :  we  know, 
however,  that  numerous  boats  coming  from  War- 
saw, arrive  daily  at  this  large  city.  But  we  are 
now  told  that  these  same  boats  have  conveyed  the 
Cholera  to  Dantzick,  situated  at  the  mouth  of  the 
Vistula ! 


142 


CONCLUSIONS  RELATIVE  TO  THE  MARCH  AND  EX- 
TENSION OF  THE  DISEASE.  BOTH  IN  ASIA  AND 
IN    EUROPE. 

That  the  Cholera  m  India,  Russia,  and  Poland, 
was  primitively,  generally,  and  essentially  propa- 
gated by  epidemic  conveyance,  is  beyond  the  pos- 
sibility of  a  doubt ;  the  facts  which  prove  it  are 
both  numerous  and  conclusive. 

Under  all  circumstances,  we  have  seen  the  com- 
municative power  of  the  Cholera  exist  in  a  con- 
stant relation,  and  in  an  exact  proportion  with  the 
violence  of  the  malady.  When  the  epidemic  was 
attended  with  most  fatal  consequences,  its  propa- 
gation was  equally  extensive.  The  power  of  prop- 
agation diminished,  on  the  other  hand,  so  soon  as 
the  epidemic  lost  its  intensity. 

In  a  great  many  places,  the  manifestation  of  the 
Cholera  has  been  preceded  by  epizooties,  more  or 
less  mortal,  the  ravages  of  which  were  exercised 
upon  different  species  of  animals. 

At  Moscow,  a  short  time  previous  to  the  appear- 
ance of  the  disease,  the  atmosphere  wTas  obscured 
by  enormous  masses  of  green  flies,  the  species  of 
which  was  not  determined.  It  seems  that  this  phe- 
nomenon has  repeatedly  presented  itself  in  Asia, 
under  similar  circumstances. 


143 

The  disease  has  been  attended  with  peculiar  vi- 
olence under  determinate  conditions  of  the  organ- 
ism. Individuals  badly  lodged,  ill-fed,  and  ill-cloth- 
ed ;  those  who  are  physically  or  morally  debilitated ; 
those  weakened  by  excesses,  of  whatever  kind  they 
may  be  ;  gluttons,  drunkards,  and  gamesters  ;  all 
persons  suffering  under  the  pernicious  effects  of 
uncleanness  or  the  abandonment  of  poverty,  were 
much  more  frequently  and  cruelly  attacked  with 
Cholera.  In  Poland,  writes  M.  Briere  de  Bois- 
mont,  the  Jews  are  the  first  subjects  of  this  mal- 
ady. 

In  India  in  general,  and  at  Dantzick,  the  disease 
attacks  men  in  particular,  and  it  is  among  them 
that  it  exercises  its  greatest  ravages  ;  at  Casan  and 
Moscow,  women  were  more  frequently  numbered 
among  the  victims  of  Cholera.  Every  where,  as 
has  appeared  hitherto,  children  are  but  rarely  at- 
tacked :  out  of  three  hundred  children  employed 
at  Casan,  in  a  manufactory,  wherein  nineteen  adult 
workmen  perished,  not  a  single  child  took  the  Chol- 
era. 

An  elevated  temperature  was  always  insepa- 
rable from  the  existence  and  propagation  of  every 
species  of  contagion,  and  more  especially  of  exotic 
contagions.  The  Cholera  is  developed,  and  has 
preserved  the  character  of  extension  which  is  prop- 
er to  it,  at  a  temperature  of  thirty  degrees  above 


144 

zero,  in  India  and  especially  Bengal,  and  at  a  tem- 
perature of  thirty  degrees  below  it,  in  Russia.* 

Every  where  the  general  duration  of  the  disease 
has  been  circumscribed  by  certain  limits  ;  we  see 
it  cease  long  before  all  the  aliments  of  propagation 
which  are  placed  within  its  reach  have  been  ex- 
hausted. 

The  disease  has  not  existed  at  all  in  several 
places  immediately  adjacent  to  those  in  which  it 
reigned  with  fury,  without  the  communications 
being  suspended,  and  without  greater  preventive 
precautions  being  adopted  here  than  there. 

The  disease  has  appeared  simultaneously  in 
places  pretty  remote  from  one  another ;  and  on 
the  other  hand,  has  not  been  at  all  manifest 
in  some  intermediate  places.  Again,  these  in- 
termediate places  have  been  invaded  several 
weeks,  months,  or  perhaps  a  year  afterwards, 
without  any  appreciable  cause  or  apparent  reasons. 

The  epidemic  Cholera  began  in  Asia,  in  the  year 
1817.  Holland  and  England,  which  keep  up  ex- 
tensive and  frequent  commercial,  political,  and  mil- 
itary relations  with  the  East  Indies,  have  not  yet 
had  the  disease.  It  is  only  within  a  few  months 
that  these  two  powers  have  adopted  preventive 
measures. 


*  According  to  Fahrenheit  the  range  would  be  from  860  to  2°. 
-Tr. 


145 

In  Europe,  as  well  as  in  Asia,  the  cases  of  re- 
lapse have  been  so  frequent,  that  it  has  become  a 
common  saying,  that  it  is  sufficient  to  have  had  the 
disease  once  in  order  to  be  more  disposed  to  contract 
it  anew,  under  the  action  of  all  the  causes  capable 
of  giving  rise  to  it. 

The  re-appearance  of  the  disease  in  the  cantons 
which  it  had  deserted,  after  having  there  made 
more  or  less  extensive  ravages,  is  frequent,  at  least 
as  much  so  as  the  examples  of  individual  relapses. 

On  the  27th  May,  1819,  the  population  of  Agra 
was  re-visited  by  the  Cholera,  the  effects  of  which 
it  had  experienced  in  the  early  part  of  July  of  the 
preceding  year.  The  disease  lasted  eighteen  days; 
and  this  second  time  it  destroyed  a  much  greater 
number  of  victims.  Calcutta,  Madras,  Moscow, 
&c,  have  presented  similar  iterations. 

Observations,  in  considerable  number,  attest 
that  change  of  situation  is  both  a  very  efficacious 
mode  of  escaping  the  disease  when  one  has  not 
yet  been  assailed  by  it,  and  a  sure  means  of  be- 
coming cured  of  it  when  its  attack  has  been 
realized. 

It  has  been  repeatedly  noticed,  that  bodies  of 
troops  seized  with  Cholera,  have  been  released 
from  it  so  soon  as  they  separated  and  divided  into 
several  detachments. 

In  the  island  of  St.  Maurice,  where  many  of  the 

14 


146 

inhabitants  were  removed  by  this  malady,  twelve 
only  of  the  Europeans  perished,  because  the  latter, 
placed  in  easy  circumstances,  immediately  remov- 
ed from  the  city. 

At  Calcutta,  in  1826,  the  population  experienced 
all  the  advantages  of  emigration,  on  the  approach 
of  the  scourge  the  inhabitants  quitted  their  dwell- 
ings, and  they  had  no  cause  to  regret  the  circum- 
stance. 

The  invasion  of  the  disease  has  generally  taken 
place  in  the  night  and  towards  morning. 

In  India  as  in  Russia,  it  has  been  remarked  that 
persons  who  escaped  the  Cholera,  though  in  the 
midst  of  the  epidemic,  experienced,  nevertheless,  the 
epidemic  influence,  which  betrayed  its  presence  to 
the  invaded  populace,  by  uneasiness,  vertigo,  syn- 
cope, anorexia,  flatulency,  constipation  or  diarrhoea. 

That  the  disease,  then,  is  capable  of  propagating 
and  transmitting  itself  to  a  distance,  is  so  evident 
a  fact,  that  it  is  scarcely  worth  while  exposing  or 
mentioning  it. 

That,  after  the  example  of  many  other  diseases, 
correctly  appreciated  in  consequence  of  having 
been  frequently  observed,  it  is  propagated  by  the 
epidemic  method,  that  is  to  say,  under  the  influence 
of  occult,  unnatural  causes,  and  in  a  sphere  of 
unbounded  and  immense    activity,  is  also   a  fact 


147 

which  no  one  denies,  and  which  every  one  pro- 
claims. 

But  with  this  mode  of  propagation  is  there  not 
another  connected ;  and  do  we  not  see  the  Cholera, 
in  many  circumstances  and  under  certain  con- 
ditions, introduced  and  established  by  the  migra- 
tion of  individuals  or  the  transportation  of  mer- 
chandize ?  In  a  word,  can  the  disease  accident- 
ally extend  in  any  other  way  than  by  epidemial 
influence?  Such  is  the  problem,  reduced  to  its 
most  simple  form  ;  and  this  the  question  which 
we  now  propose  to  discuss. 

Unfortunately,  it  is  in  vain  that  we  call  upon 
facts  and  reasoning,  experience  and  logic,  for  the 
solution  of  this  problem.  Reasoning  and  facts, 
logic  and  experience,  reciprocally  oppose,  weaken, 
or  destroy  one  another,  and  the  mind  froe  from 
everv  bias  remains  without  the  least  conviction. 

Here,  gentlemen,  let  our  attention  be  re-doubled. 

Firstly.  Districts,  cities,  and  fortresses,  have  es- 
tablished rigorous  sanatory  measures,  and  the 
Cholera  has  not  been  manifested  among  them. 

Facts  of  this  nature,  and  they  are  not  rare  in  the 
history  of  the  epidemic  under  consideration,  seem 
at  first  sight  conclusively  in  favour  of  the  non- 
epidemial  transmission. 

But  to  these  facts,  the  opponents  reply  that 
places    immediately  adjoining   those   which  were 


148 

attacked  have  escaped,  notwithstanding  every  pre- 
cautionary measure  had  been  omitted.  Might  it 
not  equally  be  retorted,  that  the  preserved  coun- 
tries which  have  adopted  pre-cautionary  measures, 
have  not  been  attacked  because  such  measures 
were  had  recourse  to  ?  The  disease  did  not  pene- 
trate these  places,  because  the  epidemial  region 
has  not  extended  thus  far. 

Secondly.  Countries,  cities,  and  fortresses,  have 
employed  the  most  severe  preventive  measures  ; 
they  have  adopted  them  in  season,  and  they  have 
vigilantly  insured  their  execution:  yet,  notwith- 
standing, they  have  been  invaded  by  the  epidemic. 
Cases  of  this  kind  are  not  rare ;  they  have  been 
observed  at  Orenburg,  Astrakan,  and  Moscow,  for 
example.  These  are  proofs,  it  would  seem,  in 
favour  of  the  exclusively  epidemic  propagation. 
But,  the  adversaries  of  this  opinion  say  in  their 
turn,  that  the  sanatory  measures,  in  these  circum- 
stances, were  not  rigorously  enforced  ;  and  they 
always  cite,  in  support,  some  cases  of  infraction  ; 
for,  in  the  present  state  of  civilization,  and  with 
the  relations  which  exist  between  nations,  cities, 
families,  and  individuals,  how  is  it  possible  to 
hinder  every  communication  ? 

Thirdly.  Cities,  fortresses,  and  bodies  of  troops, 
in  the  vicinity  of  the  epidemic  region,  and  having 
free  communication  with  it,  have  not  contracted 


149 

the  disease.  In  Europe  and  in  Asia,  facts  of  this 
nature  abound.  Irresistible  arguments,  apparently, 
against  the  transmission  by  individuals  or  mer- 
chandize. 

Not  at  all,  reply  the  antagonists.  If  the  disease 
has  not  been  communicated  in  the  midst  of  these 
circumstances,  it  is  because  the  requisite  general 
conditions,  and  the  individual  predispositions,  ne- 
cessary for  its  transmission,  did  not  exist. 

Fourthly.  Entire  cities,  villages,  fortresses,  and 
bodies  of  troops,  entered  into  communication  with 
the  epidemic  region,  have  been  infected  and 
ravaged  by  the  cholera :  the  disease  then  is  trans- 
mitted by  the  communication  of  men  and  mer- 
chandize, say  the  one ;  by  no  means,  the  others 
affirm,  the  epidemic  has  been  developed,  in  these  last 
cases,  in  the  same  manner  and  by  the  same  causes 
as  in  the  preceding,  that  is  to  say,  by  the  epidemial 
action. 

Fifthly.  Individuals  place  themselves  in  free  and 
entire  communication  with  patients  labouring  under 
Cholera:  if  they  contract  the  disease,  some  assert 
that  it  is  by  the  effect  of  communication ;  others 
affirm,  that  it  is  by  the  epidemial  action :  if  they 
do  not  contract  it,  it  is,  according  to  the  saying  of 
certain  persons,  because  the  disease  is  not  trans- 
missible in  this  way ;  and,  in  the  opinion  of  some 

others,  that  it  is  solely  owing  to  the  want,  at  this 

14* 


150 

moment,  of  the  requisite  pre-dispositions  for  con- 
tracting it,  in  these  individuals. 

How  then  can  we  escape  from  this  labyrinth  ? 
Let  us  relate  facts. 

A  member  of  a  family,  or  one  of  the  members 
of  a  house,  being  attacked,  the  disease  sometimes 
declares  itself  simultaneously,  at  other  times  suc- 
cessively, in  several  individuals  who  are  found  in 
direct  relation  with  the  one  first  seized. 

Among  domestics  in  houses,  and  servants  in 
hospitals,  the  proportion  attacked  has  sometimes 
exceeded  the  proportion  of  persons  seized  with 
Cholera  among  the  inhabitants  in  general.  At 
Moscow,  for  example,  if  the  proportion,  for  the 
population  of  the  city,  was  three  in  a  hundred, 
it  was  from  thirty  to  forty  per  cent,  among  the 
attendants  employed  in  hospitals.  In  India,  on 
the  contrary,  Annesley  has  observed,  that  the 
servants  of  hospitals  and  of  patients  in  general,  were 
not  more  frequently  seized  than  other  individuals. 

Surgeon  Major  Smirnoff  has  seen  officers,  en- 
signs and  subalterns  rendering  assistance  at  the  hos- 
pital during  the  prevalence  of  the  Cholera.  The 
city  also  furnished  the  hospital  with  many  students 
and  a  great  number  of  nurses,  at  this  period,  yet 
none  of  these  individuals  contracted  the  disease. 

In  many  countries  and  in  several  instances,  indi- 
viduals either  designedly  or  ignorantly,  have  slept 


151 

in  the  beds  just  quitted  by  patients  who  were  cured 
of  or  had  died  with  Cholera ;  they  have  clothed 
themselves  in  their  shirts  and  other  garments  ;  have 
inhaled  the  breath  of  patients  even  in  a  moribund 
state  ;  have  touched  and  agitated  the  matters  ren- 
dered by  vomiting  and  by  stool ;  have  passed  the 
night  with  the  sick,  and  in  the  same  bed  ;  physicians 
have  been  inoculated  with  their  blood,  have  injected 
it  into  their  veins,  have  rubbed  their  skin  with  the 
matter  of  perspiration  and  the  substances  ejected, 
yet  have  escaped  the  Cholera.  These  observations, 
these  diverse  experiments,  have  been  often  repeated 
during  the  epidemics  in  Asia  and  Europe.  It  is 
however  just  to  remark,  that  the  resolution,  sang- 
froid and  courage  which  generally  led  to  these 
experiments,  must  also  have  been  serviceable  in 
preventing  the  invasion  of  the  disease. 

In  all  the  places  where  I  have  been,  says  Doctor 
Boschinski,  who  besides  is  a  professed  contagionist, 
I  have  noticed  that  from  the  very  commencement, 
the  Cholera  attacked  simultaneously  a  great  num- 
ber of  individuals  who  had  not  previously  any  com- 
munication with  the  sick  ;  persons  recently  arrived 
at  places  where  the  disease  reigned,  were  especially 
attacked  before  they  could  have  had  the  least  com- 
munication with  those  afflicted  with  the  malady. 

Several  individuals  who  have  been  subjected  to 
quarantine  during  the  full  time,  have  nevertheless 


152 

fallen  sick  immediately  after,  and  without   being 
notoriously  exposed. 

On  the  other  hand,  some  facts  pretty  accurately 
observed  in  Russia,  and  especially  by  the  physicians 
of  the  government  of  Orenburg,  tend  to  prove  that, 
under  certain  determinate  circumstances,  the  ex- 
haled vapours  alone  of  the  circumscribed  atmos- 
phere of  the  sick  may  give  rise  to  the  transmission 
of  the  Cholera. 

We  have  before  noticed  the  fact  relating  to 
the  city  of  Teheran  ;  wherein  this  city  was  pre- 
served from  the  Cholera  in  consequence  of  the 
precautions  adopted  by  the  Persian  emperor,  by 
the  advice  of  the  Italian  physician  Martinengo. 

In  Persia,  the  gates  of  Ispahan  were  closed 
against  a  caravan  which  appeared  to  be  infected. 
This  caravan  was  obliged  to  pass  through  Jesda. 
Shortly  afterwards,  the  Cholera  destroyed  seven 
thousand  persons  in  this  place,  and  Ispahan  escaped 
the  scourge. 

According  to  the  report  of  Doctor  Onoufrieff, 
the  Cholera  manifested  itself  among  the  Tartars  of 
the  village  of  Kamale,  in  the  district  of  Bougdou- 
rousslausk,  on  the  10th  of  December.  The  first  vic- 
tim was  an  inhabitant  of  this  village  who  had  just 
arrived  from  Firis-Ousman,  where  the  disease 
reigned.     Next  some  of  his  relatives  died,  and  then 


153 

many  of  the  inhabitants.  The  population  of  the 
village  is  one  hundred  and  seventeen.  From  the 
10th  of  December  to  the  17th  there  were  twenty- 
eight  patients  ;  one  only  of  which  was  cured,  twelve 
are  dead,  and  thirteen  still  remained  sick  on  the  1 7th 
of  December.  Another  village  inhabited  by  Rus- 
sians, forty  sagenes*  from  the  latter,  having  been 
informed  of  the  appearance  of  the  Cholera  among 
the  Tartars,  surrounded  the  infected  village  with  a 
sanatory  cordon  and  broke  off  all  communication 
with  the  inhabitants  :  it  was  preserved  from  the 
disease. 

Our  honorable  associate  Doctor  Keraudren,  in 
his  interesting  treatise  on  the  Cholera,  relates  the 
following  fact. 

In  1822,  the  approach  of  the  Cholera  determined 
M.  De  Lesseps  the  French  Consul  at  Aleppo,  to 
take  refuge  with  all  those  who  wished  to  accompa- 
ny him,  in  a  garden  at  some  distance  from  the  city. 
His  asylum  was  enclosed  with  walls,  and  surrounded 
by  a  wide  fosse  ;  having  two  gates,  one  for  coming 
in  and  the  other  for  going  out.  So  long  as  the 
scourge  lasted,  he  admitted  nothing  from  the  ex- 
terior without  subjecting  it  to  the  precautions  ob- 
served in  Lazarettos.     In  this  colony  of  at  least 


*  230  English  feet :  a  sagene  being  equal  to  7  English  feet. 
— Tr. 


154 

two  hundred  persons,  and  composed  not  only  of 
Franks  more  or  less  acclimated,  but  also  of  several 
natives,  there  was  not  one  sick  person,  whilst  in 
the  city  four  thousand  persons  were  destroyed  by 
the  Cholera  in  the  course  of  eighteen  days. 

One  consideration,  much  more  powerful  still,  in 
the  epidemic  Cholera  of  Asia  and  Europe,  seems  to 
give  the  greatest  weight  to  the  opinion  of  the  trans- 
mission of  Cholera:  it  is  the  immense  extent  of 
country  it  has  passed  through,  in  every  direction  of 
the  horizon,  under  diverse  latitudes,  during  opposite 
seasons,  and  in  different  climates.  When  we  see 
a  disease  successively  invade  so  long  a  series  of 
regions,  pursuing  the  course  of  the  communications 
which  the  inhabitants  have  established  with  one 
another,  the  routes  which  have  been  traced  for  their 
mutual  intercourse,  are  we  not  compelled  to  con- 
sider it  as  being  propagated  by  individuals  or  mer- 
chandise, by  the  aid  of  persons  or  of  things  ? 

Medical  annals,  however,  are  not  deficient  in 
examples  of  diseases  having  thus  successively 
reigned  over  a  great  extent  of  country,  the  intro- 
duction of  which  could  not  be  attributed  to  any 
property  individually  transmissible. 

The  malady  called  trousse-galant*  which  succes- 

*  A  species  of  Ileus:  also,  the  vulgar  name  of  Cholera-Morbus. 
— Tr. 


155 

sively  pervaded  entire  Europe  in  1600,  which  should 
not  be  confounded  with  the  Cholera-Morbus,  men- 
tioned by  Zacutus  Lusitanus,  and  described  by  him 
under  the  name  of  colic,  having  previously  described 
the  Cholera  a  few  pages  in  advance — this  colic, 
Zacutus  himself  attributes  to  an  occult  cause,  a  pes- 
tilential change  in  the  atmosphere. 

Let  us  also  cite  the  epidemic  catarrhal  fever  of 
1731.  It  first  appeared  in  Connecticut :  on  the 
following  day  it  attacked  the  inhabitants  of  Massa- 
chusetts ;  two  days  afterwards,  one  half  of  the  gar- 
rison of  Annapolis  Royal  was  seized  with  it ;  and 
two  or  three  days  later  still,  the  disease  extended 
over  the  whole  of  Newfoundland.  Towards  the 
middle  of  November  it  extended  into  Saxony  and 
Russia  ;  then  making,  as  it  were,  a  retrogade  march, 
it  passed  into  Holland,  from  thence  into  Scotland, 
and  afterwards  to  London ;  after  which,  reaching 
the  extremities  of  the  territory  of  Great  Britain,  it 
penetrated  even  into  Ireland.  In  Paris,  it  was 
observed  towards  the  end  of  January ;  in  the 
month  of  March  it  reigned  at  Naples,  and  in  all  the 
southern  parts  of  Italy. 

In  order  that  we  may  approach  nearer  our  own 
epoch,  let  us  cite  the  epidemic  which  we  have 
recently  witnessed,  the  disease  of  the  hands  and 
feet,  called  " acrodynia" 


156 

The  disease,  developed  at  first  in  Paris,  has  been 
successfully  carried  to  Coulommiers,  Meaux,  Frere- 
Champenoise,  and  Montmirail.  At  the  hamlet 
Bordes,  it  caused  the  destruction  of  one  fourth  of 
its  inhabitants. 

Persons  who  took  up  their  habitation  in  those 
places  where  many  individuals  affected  with  the 
disease  were  congregated,  soon  contracted  the  dis- 
ease ;  and  if  they  quitted  these  places,  they  were 
almost  as  soon  relieved  from  the  complaint.  At 
the  barrack  of  Oursine,  at  that  of  Courtille,  raw 
soldiers  had  scarcely  arrived  before  they  were 
attacked  by  the  disease :  in  the  environs  of  Ferte- 
Gaucher  and  Coulommiers,  it  was  the  same;  indeed, 
it  was  merely  sufficient  for  a  labourer  to  commence 
working  on  an  infected  farm,  in  order  to  contract 
the  epidemic. 

Who  is  there  would  pretend  to  affirm  that  this 
disease  was  contagious,  which  besides,  resembled 
no  other,  which  was  entirely  new  to  us,  and  to 
which,  until  then,  nothing  analagous  could  be  found 
in  the  annals  of  the  science  ? 

Now  by  the  side  of  these  well-established  facts, 
of  these  assertions  which  no  one  can  contradict,  let 
us  place  what  was  written  (November  1825)  at  the 
distance  of  1500  leagues  from  us,  and  nearly  at  the 
same  epoch,  by  Dr.  Grierson,  attached  to  the  divis- 
ion of  the  English  army  at  Arracan,  and  recorded 


157 

in  the  Memoirs  of  the  Medical  Society  of  Calcutta. 
There  exists,  says  he,  a  disease  which,  I  think,  is 
peculiar  to  the  natives  of  India.  This  disease, 
having  no  nosological  title,  I  will  designate  it  by 
this  expression,  "burning  heat  of  the  feet:"  it  is  by 
this  name  that  the  natives  themselves  call  it.  There 
is  often  presented,  conjointly  with  the  malady,  fever 
and  intestinal  pains ;  frequently  also  is  the  disease 
unconnected  with  any  constitutional  or  organic 
affection. 

It  is  met  with  in  various  degrees  of  severity  ;  from 
a  painful  sensation  of  heat,  dartings  in  the  feet,  even 
to  a  burning  and  insupportable  pain  wrhich  destroys 
sleep  and  appetite,  and  at  length  preys  on  the  con- 
stitution. A  similar  pain  is  sometimes  experienced 
in  the  hands  at  the  same  time.  The  pain  of  the  feet, 
wrhen  augmented  to  a  very  great  degree,  sometimes 
mounts  along  the  tibia  as  high  as  the  knees.  There 
is  neither  inflammation,  tension,  discolouration,  nor 
any  other  notable  change  in  the  skin. 

The  disease  is  particularly  common  among  those 
classes  who  are  exposed  to  great  bodily  fatigue. 
Sometimes  the  skin  is  tumid  and  moist  to  a  certain 
extent ;  sometimes  vesicles,  filled  with  a  yellow 
serosity,  are  observable,  and  the  nails  also  occasion- 
ally assume  a  yellowish  tint. 

Several  physicians  have  observed  the  disease 
under  the  same  form.    All  have  vainly  endeavoured 

15 


158 

to  discover  a  method  of  treatment  which  would 
prove  uniformly  successful :  the  disease  has  con- 
stantly been  obstinate,  rebellious,  and  tedious.  It  is 
not  very  unusual  to  see  it  terminate  by  death.  (1.) 

Without  pretending  to  resolve  the  question,  but 
merely  with  the  hope  of  elucidating  it,  let  us  push 
our  analogical  comparisons  still  further. 

Astronomical  annals  contain  the  history  of  a  con- 
siderable number  of  diverse  meteors  which,  after 
the  manner  of  the  epidemics  we  have  just  treated 
of,  have  traversed  very  extensive  regions,  the  uni- 
form action  of  which  has  been  successively  experi- 
enced in  different  countries,  within  more  or  less 
extensive  limits,  leaving  certain  cantons  here  and 
there  unmolested,  whilst  others  have  been  more  or 
less  severely  visited  by  them. 

Our  very  honorable  colleague,  M.  Tessier,  has, 
in  a  report,  read  before  the  Academy  of  Sciences 
in  the  year  1790,  given  some  very  singular  details 
of  a  hail  storm  which  took  place  on  Sunday,  13th 
of  July,  1788. 

Six  hundred  and  fifty  square  leagues  were  rav- 
aged by  this  storm ;  its  direction  was  from  south- 
west to  north-east ;  it  passed  from  the  south-western 


(1.)  Extract  from  the  Memoirs  of  the  Physico-Medical  Society 
of  Calcutta,  Vol.  II. 


159 

extremity  of  France  even  to  the  north-eastern  ex- 
tremity of  Finland;  then  traversed  Zealand,  Hol- 
land, and  extended  even  beyond  the  Texel. 

The  appearance  of  the  storm,  as  observed  in 
France,  was  that  of  five  distinct  zones,  of  which 
two,  encased  in  the  others,  were  bands  of  hail. 
From  Touraine  even  as  far  as  Austrian  Flanders 
and  Brabant,  that  is  to  say  in  a  medium  space  of  a 
hundred  leagues,  the  two  bands  of  hail  were  al- 
ways separated,  although  by  unequal  spaces,  the 
narrowest  being  three  leagues,  and  the  broadest 
seven  leagues  and  a  half.  The  three  bands  of  rain 
were  much  more  extensive  and  irregular. 

On  either  side  of  the  limits  assigned  to  the  con- 
tinuous bands,  the  storm  had  several  interruptions ; 
and  at  the  points  where  the  bands  were  continuous 
the  borders  were  not  so  strictly  confined  as  to  pre- 
vent extensive  and  serious  discharges.  It  descend- 
ed upon  six  pretty  extensive  cantons  of  the  electo- 
rates of  Laon  and  Guise,  whilst  all  the  surrounding 
country  was  passed  over  uninjured. 

The  storm  traversed  deep  vallies,  lofty  emi- 
nences, extensive  forests,  and  broad  rivers,  especi- 
ally the  Loire  and  the  Seine.  It  discharged  hail 
in  countries  in  which  it  had  scarcely  ever  fallen 
before. 

The  meteor  swept  along  at  the  rate  of  sixteen 
and  a  half  leagues  an  hour.     The  total  duration  of 


160 

the  storm  was  only  from  seven  to  eight  minutes 
upon  each  point  which  it  traversed. 

The  trees  of  the  forest  and  those  of  large  size 
were  in  general  more  extensively  injured  than  slen- 
der trees  and  young  coppices. 

Certain  parishes  were  almost  entirely  exempt 
from  its  destructive  effects,  whilst  others  in  their 
immediate  vicinity  were  completely  laid  waste. 

In  the  year  1783,  a  thick  mist  was  seen  to  arise, 
which,  similar  to  the  storm  we  have  just  described, 
successively  spread  itself  over  a  great  extent  of 
country,  over  France,  Holland,  and  England ;  tra- 
versing these  places  irregularly,  and  also  leaving 
equally  irregular  and  direful  traces  of  its  passage. 

But  again,  these  analogies  of  epidemic  dis- 
eases, disseminated  to  a  distance,  independently  of 
every  transmission  communicated  from  man  to 
man,  or  from  merchandise  to  individuals,  and  of 
which  we  could  multiply  numerous  examples  ; 
the  resemblance  which,  in  their  mode  of  extension, 
they  bear  to  meteors,  which  travel  from  one  place 
to  another,  attacking  by  preference  certain  local- 
ities, are  not,  we  are  well  aware,  adequate  to  the 
complete  solution  of  the  question  under  considera- 
tion, but  they  may  hereafter  lead  to  it. 

These  analogies,  these  resemblances  enlarge  the 
field  of  observation  ;  they  recall  the  attention  to 
other  series  of  events ;  and  the  understanding,  ha- 


161 

# 
bituated  to  consider  the  phenomenon  under  points 

of  view  less  circumscribed,  may,  at  some  future 
day,  derive  from  this  consideration  more  satisfac- 
tory solutions. 

In  the  meantime,  let  us  say  something  of  the 
prophylactic  means  which  the  Cholera  demands 
under  the  present  state  of  our  knowledge. 


15 


* 


PART  EIGHTH. 


PROPHYLAXIS.— SANATORY  MEASURES 

In  consequence  of  the  immense  improvement  in 
social  relations,  during  the  last  forty  years,  as  well 
as  from  the  effect  of  the  advancement  of  the  natu- 
ral and  medical  sciences,  hygiene,  both  public  and 
private,  has  made  so  much  progress  in  France,  that 
we  cannot  resist  this  opportunity  of  announcing  our 
expectations  of  being  preserved  from  the  epidemic 
invasion  of  cholera,  or  at  least  of  seeing  its  cruel 
devastations  diminished  and  extinguished  at  our 
doors.  Look  at  what  happened  with  regard  to  ty- 
phus in  the  years  1814  and  1815.  In  consequence 
of  the  two-fold  invasion,  of  painful  memory,  the  latter 
malady  had  made  extensive  ravages  in  Germany 
and  our  Rhenish  provinces :  it  reached  even  Paris, 
where,  both  in  the  city  and  hospitals  we  had  cases 
of  typhus  developed,  in  consequence  of  the 
numerous  bodies  of  troops  by  which  we  were  in- 
vaded. The  disease,  however,  could  not  obtain 
firm-footing  in  the  midst  of  the  dense  population  of 
this  capital,  being  opposed  by  the  daily  increasing 
comforts  of  civilization,  the  amelioration  in  the  con- 


163 

dition  of  individuals,  the  advancement  in  knowledge, 
and  the  progress  of  hygieine. 

In  order  that,  with  regard  to  cholera,  we  mav  ar- 
rive  at  similar  and  even  more  happy  results,  we  will 
notice  two  kinds  of  prophylactic  measures — those 
which  relate  to  individuals  or  society,  and  those 
which  are  derived  from  private  or  public  hygieine. 

The  disease  commences,  as  wTe  have  seen,  with 
derangements  of  the  functions  of  the  cutaneous  tis- 
sues, of  which  the  mucous  membranes  are  only  a 
kind  of  continuation  or  dependency.  It  is  estab- 
lished upon  the  concentration  of  the  vital  forces  at 
the  interior,  and  upon  the  general  effects  of  a  very 
peculiar  catarrhal  affection :  Hence,  to  maintain  the 
normal  state  of  the  perspiration,  to  avoid  the  causes 
which  tend  to  produce  a  catarrhal  condition  of  the 
gastro-intestinal  mucous  surfaces,  to  prevent  the 
perversion  of  the  nervous  function  and  its  conse- 
quences, these  are,  summarily,  the  measures  which 
experience  has  taught  to  be  salutary  as  it  regards 
the  private  hygieine. 

It  is  necessary,  in  the  first  place,  that  the  mind 
should  be  kept  in  a  calm  and  sober  state,  free  from 
every  species  of  anxiety  and  distress.  Regular 
habits,  temperance  and  agreeable  society  are  also 
conducive  to  the  bodily  welfare.  Ambition,  sorrow, 
fear,  moral  agitations,  and  in  general  the  violent 
passions,  of  whatsoever  nature  they  may  be,  thrown 


164 

into  irregular  and  unrestained  action,  become  so 
many  certain  causes  of  the  disease. 

It  is  requisite  also,  that  the  air  should  be  pure, 
exempt  from  every  species  of  vitiation  resulting 
even  accidentally,  from  numerous  assemblages  of 
men  or  animals ;  for  it  is  especially  in  the  midst  of 
a  dense  and  excessively  crowded  population  that 
the  cholera  arises  and  is  propagated. 

Humidity,  in  whatever  form,  manner  or  combina- 
tion it  may  present  itself,  must  be  carefully  avoid- 
ed. Cold  and  moisture,  heat  and  moisture,  have 
almost  an  equal  power  in  producing  the  cholera. 
Care  should  be  taken  to  keep  in  a  dry,  elevated 
situation,  under  a  salubrious  exposition,  at  a  dis- 
tance from  evaporations  arising  from  considerable 
collections  of  water,  especially  of  stagnant  water. 
The  interior  of  habitations  should  be  exempt  from 
humidity,  protected  from  unwholesome  exhalations, 
spacious,  properly  aired,  easy  of  ventilation,  in  a 
state  of  cleanliness,  and  at  all  times  kept  free  from 
every  encumbrance  of  men  and  animals  of  whatso- 
ever species  they  may  be. 

It  is  under  circumstances  similar  to  those  we  are 
now  considering,  that  the  ordinary  regimen  of  hos- 
pitals is  found  insufficient  or  even  misunderstood. 
It  would  be  well  to  have  the  power  of  encamping 
patients  or  of  locating  them  by  themselves  in  bar- 
racks eligibly  situated.     Particular  houses  should 


165 

also  be  set  apart  for  the  reception  of  convalescents, 
in  order  that  they  may  be  removed  from  the  sick  as 
soon  as  possible,  since  experience  teaches  us  that 
relapses  very  readily  and  frequently  occur,  under 
the  influence  of  conditions  susceptible  of  giving  rise 
to  the  cholera. 

The  clothes  must  be  kept  particularly  dry  and 
clean  ;  they  should  always  be  sufficient  without 
ever  being  slight ;  rather  warm  than  otherwise,  but 
especially  in  relation  with  the  real  state  of  the  at- 
mosphere, still  more  so  with  the  season.  Experi- 
ence has  shewn  the  advantage  of  flannel  girdles 
worn  next  the  skin. 

Among  the  number  of  hygieinic  measures  which 
may  serve  to  prevent  the  invasion  of  the  Cholera, 
let  us  mention  dry  frictions,  spirituous  aromatic 
frictions,  the  common  warm  bath,  compound,  cold, 
or  sea- water  baths,  according  to  circumstances: 
the  bathing  especially,  which  is  now  extensively 
used  by  all  classes  of  people,  must  have  an  admi- 
rable tendency  to  preserve  us  from  the  attacks  and 
progress  of  Cholera.  We  cannot  be  too  cautious, 
however,  in  guarding  against  the  humidity  which  is 
apt  to  follow  the  use  of  the  bath  when  taken  with- 
out proper  precaution. 

Constant  caution,  with  regard  to  aliment,  is  a 
matter  of  the  highest  importance.  It  is  almost  al- 
ways after  deviations  in  regimen  and  excesses  at 


166 

table,  that  the  disease  supervenes  ;  and  it  is  espe- 
cially necessary  that  attention  should  be  paid  both 
to  the  quantity  and  quality  of  food  taken  as  nour- 
ishment. 

The  aliments  most  appropriate  are  those  which 
maintain  an  even  balance  between  decided  debility 
and  redundant  health ;  and  those  drawn  from  the 
animal  should  predominate  over  those  of  the  vege- 
table kingdom.  But  let  us  dispense  with  these  fas- 
tidious details  of  substances  adapted  to  every  condi- 
tion exacted  by  the  prophylaxis  of  Cholera;  we 
would  much  rather  state  what  ought  to  be  avoided 
than  what  should  be  selected.  Full-grown,  smoked, 
salted,  and  fat  meats,  farinaceous  or  mucilaginous 
vegetables,  milk,  in  great  abundance,  and  watery 
fruits,  have  generally  been  prejudicial. 

Drinks,  of  a  bad  or  even  indifferent  quality,  should 
be  placed  first  in  the  list  of  causes  which  predispose 
to  the  Cholera.  All  liquids  which  readily  undergo  the 
process  of  fermentation,  and  which  are  so  common 
and  numerous  in  the  north;  all  drinks  prepared  in 
Asia  with  mare's  milk  and  fermented  rye ;  brandy  and 
strong  cordials,  the  abuse  of  which  is  much  more  pre- 
valent in  those  countries  in  which  the  vine  is  not  cul- 
tivated, are  so  many  drinks  which  predispose  to  the 
invasion  of  the  Cholera.  Nations,  to  whom  nature 
has  given,  with  the  vine,  water  of  a  good  quality,  to 
whom  she  has  specially  imparted  the  gift  of  making 


J 


167 

only  a  moderate  use  of  these  articles  are   much 
more  highly  favoured  than  they  are  aware  of. 

The  hygieinic  rules,  quite  the  reverse  of  the  ther- 
apeutic, are  nearly  the  same  for  every  individual. 
The  slight  modifications  which  the  hygieine  of  cer- 
tain persons  demand,  will  be  easily  determined  by 
the  individuals  themselves,  from  the  knowledge 
which  each  has  of  his  temperament,  tolerances,  and 
repugnancies. 

Under  the  title  of  dis-infecting  agents,  camphor, 
vinegar,  Guytonian  fumigations,  lime-water,  the 
chlorides,  &c.  have  been  frequently  resorted  to. 
Experience  will  develope  the  efficacy  of  these 
agents. 

It  is  to  public  hygieine  that  appertain  the  clean- 
liness and  salubrity  of  cities,  towns  and  villages  ; 
the  direction,  draining,  and  purification  of  marshes, 
ponds,  and  margins  of  rivers  ;  the  inspection  of 
every  sort  of  provisions  ;  the  amelioration  of  the 
indigent  classes,  whose  subsistence  should  be  liber- 
ally provided;  the  dispensation  of  that  assistance 
which  these  classes  require  ;  the  impartingof  advice 
and  consolation  of  which  thev  stand  in  need ;  the 
lodging  of  troops  in  barracks  and  encampments  ;  the 
movements  of  armies  ;  the  organization  of  proviso- 
ry hospitals  and  retreats  for  convalescents,  in  case 
of  need;  the  physical  and  moral  regimen  of  prisons, 
and  the  arrangement  of  work-shops  and  manufac- 


168 


tories.  In  concert  with  physicians,  as  well  as 
with  wealthy  and  enlightened  citizens,  the  public 
authorities,  guided  moreover  by  the  rules  of  private 
hygieine  which  we  have  just  laid  down,  will,  at  all 
times  possess  the  prudence  and  foresight  to  antici- 
pate every  need  and  supply  every  deficiency.  In 
fine,  public  hygieine  is  merely  private  hygieine  on  a 
larger  scale, — hvgieine,  extended  from  individuals  to 
assemblages,  and  from  domestic  necessities  to  the 
exigencies  of  society  at  large. 

The  administrative  authorities  should  be  particu- 
larly vigilant  in  seeing  that  the  sick  are  visited  and 
assisted  speedily.  M.  Briere  de  Boismont,  in  one 
of  his  letters  from  Warsaw  to  M.  Esquirol,  has 
clearly  pointed  out  the  necessity  of  this  vigilance. 

But  to  the  public  hygieine  also  appertain  those 
sanatory  measures  which  may  be  demanded  by 
the  disease  and  authorised  by  our  laws.  On  this 
point  the  academy  is  officially  invested  this  day 
with  a  duty  of  the  highest  importance ;  it  must 
pronounce  upon  the  fitness  of  these  measures. 

We  have  already  said,  we  have  already  shewn, 
that  some  facts  noted,  in  Europe  especially,  and  of 
which  we  have  also  perceived  the  indices  in  Asia, 
seem  to  prove  that,  under  certain  circumstances, 
individuals  who  have  lived  in  the  very  hot-bed  of 
the  epidemic,  or  have  merely  traversed  it,  may  carry 
the  disease  with  them  to  the  places  whither  they 


169 


are  going,  though  these  travellers  themselves  re- 
main exempt  from  the  Cholera. 

Analagous  facts  induce  the  suspicion  that  indi- 
viduals attacked  with  the  disease,  have  been  able, 
under  certain  circumstances,  to  transmit  it  to  the 
inhabitants  of  the  country  into  which  they  have 
been  transported,  or  even  to  the  persons  by  whom 
they  are  surrounded. 

Lastly,  other  facts,  and  they  are  not  few,  tend 
to  imply  that  the  disease  is  propagated  from  one 
place  to  another  by  the  numerous  routes  of  com- 
munication. Let  us  state  here,  however,  with  a 
view  to  the  interest  of  commercial  relations,  that 
we  have  not  seen  any  positive  fact  mentioned 
from  any  source,  which  decidedly  proves  that 
the  Cholera  is  communicated  by  the  transporta- 
tion of  merchandize ;  individuals  and  their  ac- 
quaintances alone  seem  to  have  given  cause,  in 
some  instances,  for  accusation  or  suspicion. 

Notwithstanding  the  facts  of  this  order  are,  in 
our  opinion,  uncertain,  imperfect,  and  vague,  and 
may  all  be  conceived  and  explained  solely  by  the 
laws  which  govern  epidemics  ;  yet  will  it  suffice 
us,  so  far  as  the  science  and  our  own  conviction  are 
concerned,  to  have  emitted  this  opinion  :  and  hav- 
ing before  our  eyes  what  has  already  been  consum- 
mated in  France,  on  this  subject ;  guided  by  the 
example  of  neighbouring  nations,  all  of  whom  have 

16 


170 

adopted  precautionary  measures,  and  shuddering  at 
the  dangers  to  which  humanity  might  be  exposed, 
the  committee  do  not  hesitate  to  recommend  unan- 
imously, the  sanatory  measures  authorised  by  the 
law  of  the  3d  of  March,  1822,  or  the  ordonnance 
of  the  7th  of  August,  of  the  same  year. 

The  Academy  cannot  terminate  this  part  of  its 
report  without  specifying  to  the  government  the 
difference  which  exists  between  sanatory  regula- 
tions as  applied  to  inland  cities,  towns,  and  vil- 
lages, and  the  sanatory  regulations  in  use  in  mari- 
time towns. 

In  sea-ports,  every  thing  that  concerns  sanatory 
police  goes  on  smoothly,  regularly,  and  even  in- 
nocently; but    is   it   the   same    as    regards  other 
places  ?     The    quarantines   and    military   cordons 
stationed  around  a  city  in  which    a   disease   re- 
puted   transmissible,   prevails,   in   addition  to  the 
demoralization   which    is    the    deplorable    conse- 
quence of  them,  have  also  the  fatal  effect  of  re- 
pelling, of  concentrating  populations  upon  them- 
selves,   of  augmenting   the    want    of  succour   of 
every  kind,  of  adding  to   the   terror   and  tumult 
which  there  already  reign,  and  thereby  excessively 
promoting  the  increase  of  the  evil :  these  are  so 
many  serious   inconveniences  which  it  would  be 
advisable  to  avoid. 


171 

Finally,  the  Academy  has  only  been  enabled  to 
work  from  documents,  the  accuracy  of  which  it 
cannot  guarantee,  and  from  which  it  has  often 
desired  more  copious  details  and  deeper  investiga- 
tion. Placed  at  a  distance  from  the  theatre  of 
facts,  it  has  accumulated,  assimilated,  compared, 
analysed,  and  scrutinized  them,  and  the  con- 
clusions which  naturally  proceed  from  them,  are 
those  which  we  now  present  to  the  government 
and  the  public. 


GENERAL    SUMMARY 


AND 


CONCLUSIONS. 


After  laborious  research,  a  prolonged  examination 
of  documents  intricately  connected,  after  deep 
investigation  of  authors  who  have  described  the 
Cholera  in  the  different  countries  in  which  it  has 
appeared,  and  a  methodical  and  critical  analysis  of 
the  numerous  facts  collected  on  this  subject,  the 
Academy,  happy  in  responding  both  to  the  solici- 
tudes of  the  public  and  the  confidence  of  the  Gov- 
ernment, hastens  the  publication  of  the  result  of  its 
deliberations. 

The  Cholera-morbus  is  a  disease  which  has  been 
known  and  studied  in  every  age  and  nation,  and 
has  been  a  matter  of  controversy  in  every  school. 

Our  classics  have  successively  described  it — in  the 
form  of  a  sporadic  disease,  in  which  it  has  at  all 
periods  presented  itself  isolately,  attacking  only 
one  or  at  least  attaining  but  to  few  individuals  at 
the  same  time  ; 


173 

In  the  catastatic  or  milder  epidemic  form,  in 
which  several  individuals  are  attacked  at  the  same 
time,  under  the  influence  of  a  distinct  and  protracted 
medical  constitution ; 

In  the  form  of  an  endemic,  in  which  the  disease 
is  produced  by  the  influence  of  particular  localities 
in  warm  climates ;  as  has  been  observed  in  the 
East,  in  Hindostan,  in  Italy,  &c.  ; 

In  the  form  of  a  symptomatic  affection,  of  an 
accumulated  series  of  symptoms  intimately  connect- 
ed with  diverse  acute  diseases,  such  as  high  grades 
of  bilious,  typhoid  and  yellow  fevers,  intermittent? 
remittent,  pernicious,  &c. 

Under  these  different  states  and  circumstances, 
the  Cholera  has  never  shewn  itself  transmissible. 
Never  has  it  extended  beyond  the  causes  which 
excited  it ;  never  has  it  overleaped  the  boundaries 
in  the  sphere  of  which  it  was  developed.  Whence 
this  rigorous  conclusion,  that  the  Cholera  is  not 
primitively,  naturally  and  essentially  transmissible. 

Except  in  intensity,  gravity,  rapidity,  and  danger, 
the  epidemic  Cholera  differs  but  little  from  the 
ordinary  Cholera,  with  which  we  have  been  so  long 
acquainted. 

Hence,  the  epidemic  Cholera  of  India  is,  as  to  its 
symptoms,  the  Cholera  of  the  ancients.  The  nu- 
merous descriptions  which  we  possess  of  it,  com- 

16* 


174 

pared  with  that  handed  down  by  Arseteus,  suffi- 
ciently attest  it. 

The  Cholera  observed  in  Russia,  with  equal  uni- 
formity presents  the  same  symptoms  as  the  Cholera 
of  India. 

Lastly,  the  Cholera  of  Poland  has  in  like  manner 
manifested  the  same  character. 

In  India  as  well  as  in  Russia,  the  Cholera  is  found 
pretty  well  defined  by  the  following  symptoms,  by 
which  we  may  always  readily  recognize  it :  epigas- 
tral  pains,  anxiety,  vertigo,  repeated  vomitings,  fre- 
quent stools ;  the  matters  discharged  at  first  com- 
posed of  recently  ingested  substances,  but  soon  be- 
coming fluid,  whitish  and  flocculent ;  violent  cramps, 
contractions  of  the  superior  and  inferior  extremi- 
ties, coldness  of  the  body  ;  suppression  of  urine  ; 
the  skin  of  the  hands  and  feet  pale,  cold,  moist  and 
wrinkled  ;  distortion  of  the  features,  hippocratic 
countenance  ;  sinking  and  complete  disappearance 
of  the  pulse,  and  total  absence  of  vital  re-action. 

On  this  point,  the  symptomatology  of  the  epidemic 
Cholera,  there  is  no  difference  of  opinion.  In  the 
East  and  West  Indies,  in  Russia  and  Poland,  the 
descriptions  are  every  where  identical. 

Nothing,  on  the  contrary,  is  more  variable  than 
the  statements  given  of  the  necroscopic  characters 
of  the  disease.     Deep  meditation  upon  a  very  great 


175 

number  of  autopsic  examinations  which  we  have 
closely  investigated,  lead  to  the  following  results  : 

1.  The  pathological  lesions  discovered  after 
death  caused  by  the  Cholera,  in  India  as  well  as  in 
Russia  and  Poland,  are  slight,  variable,  dissimilar, 
and  even  discordant. 

2.  In  a  given  system  of  organs,  in  the  brain  and 
its  dependencies,  in  the  digestive  tube  and  its  ap- 
pendages, in  the  heart  and  the  large  vessels  which 
proceed  from  it,  these  lesions  have  no  fixed  seat, 
still  less  have  they  a  definite  character. 

3.  In  a  great  number  of  cases,  the  most  scrupu- 
lous observers  affirm  that  they  have  not  found  any 
appreciable  alteration. 

4.  Very  frequently  also,  the  lesions  described 
present  no  determinate  character ;  they  do  not 
differ  from  those  which  are  observed  after  death 
produced  by  certain  acute  diseases,  by  those  espe- 
cially which  are  remarkable  for  the  dreadful  rapidity 
of  their  progress  and  the  suddenness  of  their  fatal 
termination. 

5.  It  has  been  generally  affirmed  that  the  more 
violent  the  disease,  that  is  to  say,  the  more  speedy 
its  fatal  termination,  the  less  sensible  have  been  the 
pathological  lesions. 

6.  The  intensity  of  the  various  lesions  found  after 
death  from  the  Cholera,  have  generally  been  in  a 
direct  ratio  to  the  duration  of  the  disease. 


176 

7.  One  fact,  which  has  been  pretty  frequently 
attested  in  the  pathological  anatomy  of  the  Indian 
Cholera,  is  the  whitish  cream-like  matter  adherent 
to  the  surface  of  the  mucous  membranes. 

The  Cholera,  as  to  its  nature,  is  a  complex 
malady.  It  is  a  complication  resulting  from  a  gen- 
eral diminution  in  the  energy  of  the  nervous  system 
and  a  particular  catarrhal  affection,  combined  in 
various  degrees. 

Either  of  these  morbid  conditions  is  susceptible 
of  predominating  to  such  a  degree  as  to  claim  more 
particularly  the  attention  of  the  physician,  according 
to  the  constitution  of  the  individual,  the  stage  of  the 
disease,  &c. 

The  predominancy  of  the  catarrhal  over  the  ner- 
vous affection  principally  depends  upon  the  stages 
of  the  disease,  and  vice  versa. 

In  the  first  stage,  the  nervous  affection  usually 
predominates ;  in  the  second,  the  catarrhal  state  is 
most  prominent. 

Almost  alwavs,  however,  the  two  stages  are 
united,  blended,  and  confounded :  with  them  are 
also  combined  and  blended  the  phenomenal  char- 
acteristics of  the  two  pathological  states.  Then  is 
it  that  the  disease  is  elevated  to  its  highest  degree 
of  intensity,  and  it  is  then  that  all  the  attention  and 
all  the  sagacity  of  the  enlightened  observer  are  re- 
quired in  order  to  lay  hold  of  the  indications. 


177 

The  disease  is  naturally  very  malignant :  individ- 
uals deprived  of  the  assistance  of  art  almost  invaria- 
bly die.  The  chances  of  recovery  are  greatest 
when  the  physician  arrives  at  the  period  of  immi- 
nence or  invasion  of  the  disease,  and  when  the 
method  of  treatment  employed  coincides  with  the 
special  forms  which  the  disease  assumes  in  particu- 
lar cases. 

In  several  places  ravaged  by  the  Cholera,  statis- 
tical summaries  have  been  published,  giving  the 
relative  number  of  cases,  deaths,  and  cures,  with 
the  probable  numerical  chances  of  each  of  these 
terminations  ;  but  the  data  on  which  these  numeric- 
al calculations  are  based,  are  so  indefinite,  that  the 
Academy  would  not  even  assume  the  mere  respon- 
sibility of  the  citation. 

The  lo^ic  of  facts  combine  with  the  logic  of  the 
doctrines,  to  shew  that  we  cannot  designate  an  uni- 
form treatment,  and  still  less  a  specific  remedy, 
applicable  to  all  the  cases  of  Cholera. 

Individualities,  which  modify  in  a  striking  man- 
ner the  morbid  condition,  exact  a  corresponding 
modification  in  the  therapeutic  agents. 

The  only  general  advice  which  we  can  give  upon 
this  point,  must  be  summed  up  in  the  clinical  indica- 
tions. To  rouse  the  depressed  nervous  energy,  to 
augment  and  render  its  distribution  more  uniform 


178 

and  regular ;  to  stimulate  and  warm  the  chilled  sur- 
faces of  the  skin ;  to  re-invigorate  the  vital  powers  ; 
these  are  the  predominant  and  capital  indications  of 
the  epidemic  Cholera. 

Next  to  attack  the  catarrhal  affection  by  the  aid 
of  such  means  as  have  been  ascertained  by  experi- 
ence to  have  been  productive  of  the  most  success- 
ful results,  constitutes  another  analytical  indication 
of  almost  equal  importance. 

Lastly,  to  combat  the  symptoms,  in  a  direct  ratio 
to  their  urgency  and  relative  predominancy,  this  is 
a  secondary  symptomatic  indication,  which  is  equal- 
ly to  be  attended  to. 

The  method  of  accomplishing  this  threefold  pur- 
pose, must  vary  according  to  the  individuality,  the 
epoch  of  the  epidemic,  &c.  It  is  only  from  the 
accurate  perception  and  experienced  tact  of  the 
physician,  that  we  must  expect  those  applications 
which  may  demand  success. 

The  disease  under  consideration  is  remarkable 
and  dreadful,  beyond  every  other  malady,  in  con- 
sequence of  the  fatal  extensions  which  it  has  made. 
Taking  it  up  from  its  commencement,  the  latter 
part  of  August,  1817,  and  carrying  it  down  to  the 
present  day,  the  Cholera,  arising  in  the  Delta  of  the 
Ganges,  has  extended  from  lower  Bengal,  its  cradle, 
to  the  isles  Mauritius  and  Timor,  near  New  Holland, 


179 

in  the  southern  direction.  Towards  the  east,  it  has 
appeared  at  Kussuchou,  a  Russian  village,  at  Pekin 
and  even  eastward  of  this  place.  On  the  side  of 
the  north,  it  has  gained  the  frontiers  of  Siberia  and 
Astrakan  as  far  as  Archangel.  Finally,  on  the  west, 
it  has  attacked  Moscow,  St.  Petersburg,  extending 
its  course  from  Dantzig  to  Olmutz  ;  and  slightlv 
declining  towards  the  south,  it  has  accompanied  the 
armies  of  Russia  into  the  very  heart  of  Poland. 

The  disease  then  has  successively  invaded  an 
immense  extent  of  country,  in  every  direction  of 
the  horizon,  during  opposite  seasons  and  in  very 
different  climates. 

The  disease,  as  is  shewn  by  an  immense  majority 
of  facts,  is  extended  and  propagated  in  the  epi- 
demial  way,  and  especially  under  the  influence  of 
predisposing  causes,  the  chief  of  which  are  :  hu- 
midity, sometimes  combined  with  heat,  sometimes 
with  cold  ;  frequent  atmospheric  vicissitudes  ;  large 
assemblages  of  men  ;  the  encampments  and  marches 
of  considerable  masses  of  troops  ;  excess  in  eating 
and  drinking  ;  debauch,  uncleanness,  poverty ;  in- 
habiting low  and  damp  situations  ;  dwellings  badly 
ventilated,  or  encumbered  with  men  or  animals ; 
violent  agitations  of  the  mind ;  aliments  and  drinks 
of  a  bad  quality,  difficult  of  digestion  and  disposed 
to  fermentation. 


180 

We  may  hope  to  be  preserved  from  the  disease 
by  keeping  aloof  from  the  various  predisposing 
causes  just  mentioned. 

Notwithstanding  the  cholera,  the  history  of  which 
we  have  just  traced,  may  be  primitively  and  es- 
sentially cpidemial,  we  may  however  infer  from 
facts  that,  under  certain  circumstances,  it  can  be 
propagated  by  the  migration  of  individuals  ;  and 
even  though  these  facts  may  only  be  of  value  so 
far  as  they  excite  suspicions  and  give  rise  to  doubts, 
yet  are  we  in  duty  bound  to  take  cognizance  of 
them,  and  adopt  corresponding  precautionary  meas- 
ures :  the  prudence  of  nations  demands  it. 

We  have  already  noticed  that  the  Cholera- 
morbus  is  very  apt  to  follow  in  the  train  of  large 
assemblages  of  troops,  in  consequence  of  the  priva- 
tions, fatigues  and  excesses  which  usually  attend 
upon  the  life  of  a  soldier. 

We  rejoice,  Gentlemen,  that  the  voice  of  human- 

■I 

ity  has  at  length  been  heard.  You  have  now  no 
cause  to  frame  the  wish,  that  Diplomacy,  that 
European  representation  of  the  desires  and  interests 
of  nations,  should  interfere  in  these  calamitous  cir- 
cumstances. It  is  now  proclaimed  to  the  whole 
world :  France,  by  the  voice  of  her  King,  or  the 
King,  declaring  the  wishes  of  his  people,  "  will  en- 


i 


181 

deavour  to  preserve  the  South  of  Europe  from  the 
scourge  of  the  contagion  which  war  propagates." 
It  is,  Gentlemen,  from  this  circle  especially,  that 
the  first  acclamations  of  gratitude  should  ascend. 

July  25,  1831. 

(Signed) 

KERAUDREN,    President; 

CHOMEL, 

MARC, 

DESGENETTES, 

DUPUYTREN, 

LOUIS, 

EMERY, 

DESPORTES, 

BOISSEAU,  and 

PELLETIERj 

DOUBLE,  Reporter. 

By  the  Academy, 


ADELON,  Annual  President ; 
Bon.  PORTAL,    Honorary  # 

Perpetual  President; 
PARISET,  Perpetual  Secretary. 


END  OF  THE  FIRST  PART. 


17 


SECOND  FART. 


REPORT 


ON   THE 


CHOLERA- MORBUS, 


READ 


13TH  SEPT.    1831. 


REPORT 


ON    THE 


CHOLERA-MORBUS. 

READ  AT  A  GENERAL   SESSION  OF   THE   ROYAL 
ACADEMY  OF  MEDICINE,  SEPT.  13,  1831. 


GENERAL  CONSIDERATIONS. 

Among  the  most  remarkable  and  dreadful  phenom- 
ena of  the  Cholera-morbus,  must  incontestably  be 
ranked  the  character  of  extension  which  the  disease 
affects.  Already  has  almost  the  whole  of  the  conti- 
nent of  Asia  been  pervaded  by  it ;  a  part  of  Europe 
is  now  found,  either  attacked  or  immediately  threat- 
ened by  this  scourge,  and  we  also  have  great  rea- 
son to  apprehend  its  cruel  invasion.  Having  studied 
the  march,  symptoms,  necroscopic  characters,  seat, 
nature,  treatment,  and  terminations  of  this  fatal 
malady,  the  Royal  Academy  of  Medicine  has  spe- 
cially directed  its  practical  inquiries  to  the  means 
of  preventing  it. 

Here  the  prophylaxis  of  the  disease,  the  duties 
and  difficulties  are  spread  over  a  widely  extended 
field.  ^ 

17* 


186 

The  civil  authorities,  the  members  of  the  medical 
profession,  and  citizens,  will  all  have  obligations  to 
fulfil  and  precautionary  measures  to  adopt.  These 
obligations,  and  precautions  must  necessarily  vary 
according  to  the  nearness  of  approximation  of  the 
disease  to  a  nation,  or  its  actual  invasion. 

The  advices  then,  which  the  Academy  is  called 
upon  to  give  on  this  subject,  will  be  arranged  under 
two  different  sections ,  the  one  relating  to  the  sup- 
position that  the  disease  is  simply  threatened,  the 
other  to  its  actual  invasion. 

These  advices  will  also  be  addressed  succes- 
sively : 

1.  To  magistrates  of  everv  class  ; 

2.  To  physicians  of  every  order  ; 

3.  To  citizens  of  all  conditions. 

The  object  of  these  advices  will  be  to  specify 
in  detail  what  each  should  perform  within  the  limits 
of  his  duties,  faculties,  means  and  jurisdiction. 

But  let  us  proceed  to  declare  in  the  first  place  : — 
France,  fortunately,  is  not  placed  in  either  of  the 
conditions  embraced  in  the  plan  which  the  Academy 
has  just  traced. 

Blessed  with  a  most  advantageous  geographical 
position,  a  serene  sky,  temperate  climate,  fruitful 
soil  and  a  happy  distribution  of  territorial  property, 
with  industrious  habits,  instruction  pretty  generally 
distributed  and,  consequently,  with  a  public  and 
private  hygieine  which  leaves  but  little  to  be  de- 


187 

sired,  the  French  have  reason  to  hope  that  they  will 
be  preserved  from  the  visitation  of  this  scourge. 

Besides,  in  general,  the  probabilities  and  espe- 
cially the  risk  of  propagation  of  Cholera  beyond  the 
limits  of  the  localities  actually  invaded,  always  go 
on  diminishing.  The  torrent  seems  to  excavate 
a  bed  less  broad  and  deep,  in  proportion  as  it  con- 
tinues to  extend,  and  according  as  it  attacks  more 
enlightened  and  prosperous  nations,  especially  those 
who  pay  strict  attention  to  cleanliness. 

What  if,  contrary  to  these  anticipations,  the  dis- 
ease should  attack  us,  have  we  not  every  reason  to 
presume  that  its  force  will  be  diminished  by  the 
hygieinic  conditions  in  which  we  are  found  placed  ? 

Let  us  again  relate  in  few  words  what  happened 
with  regard  to  the  typhus  of  1814-15. 

The  disease  had  made  extensive  ravages  in  the 
two  armies,  both  among  the  victors  and  the  van- 
quished. The  two  banks  of  the  Rhine  had  griev- 
ously suffered  by  it.  The  disease  extended,  though 
gradually  diminishing  in  intensity,  even  to  the  bor- 
ders of  the  Loire.  Soldiers  attacked  with  typhus 
entered  our  hospitals  in  great  numbers.  Many  of- 
ficers and  servants  also  carried  the  disease  into  the 
different  quarters  of  the  city.  The  French,  the 
inhabitants  of  the  capital  especially,  endured  with 
great  irritation  and  impatience,  the  presence  of  the 
armies  of  occupation  ;  yet  notwithstanding  all  these 
distressing  circumstances,  the  typhus  could  not  es- 


188 


tablish  itself  amongst  us.  It  became  extinguished 
in  the  midst  of  the  prosperity  and  comfort  which  the 
inhabitants  of  the  capital  and  the  central  provinces 
enjoyed.  ■ 

There  is  also  the  more  propriety  in  insisting  upon 
this  consideration,  in  this  place,  from  the  fact  that 
typhus,  under  certain  circumstances,  and  especially 
since  the  Cholera  has  manifested  itself  in  Europe, 
constitutes  in  some  degree  one  of  the  terminations 
of  this  malady.  Such  facts,  doubtless,  also  add  to 
the  chances  of  preservation  which  we  enjoy. 

Nevertheless,  the  extension  to  a  distance  of  the 
Cholera,  as  it  now  reigns  over  several  parts  of  Eu- 
rope, is  an  incontestable  fact ;  this  enormous  fact 
surely  implies  causes  which  are  peculiar  to  it,  and 
the  knowledge  of  the  causes  of  this  phenomenon 
would  be  of  immense  benefit  to  mankind. 

We  may  safely  affirm,  however,  that  the  special 
manner  in  which  the  Cholera  is  developed,  the  es- 
sential cause  of  its  extension,  are  entirely  unknown 
to  us  ;  this  is,  at  the  present  day,  the  most  essential 
point  to  be  illustrated  in  the  general  history  of  the 
disease  ;  it  is  this  which  should  be  proposed  to  the 
investigations  of  learned  men  in  every  country. 
Upon  other  questions,  which  are  connected  with 
the  pathology  of  Cholera,  observation  has  not  left 
us  entirely  destitute  of  guides  and  illustrations  ;  we 
have  notions,  we  possess  data  which  are  peculiar  to 
this  disease.     But  as  to  the  mode  of  transmission 


189 

setting  aside  simple  general  ideas,  we  have  yet 
every  thing  to  discover,  almost  every  thing  to  learn. 

But,  by  way  of  retaliation,  we  do  positively  know 
that  the  co-union,  the  concurrence  of  a  certain  se- 
ries of  circumstances,  singularly  favor  the  disastrous 
march  of  this  scourge.  Such  are  great  and  fre- 
quent atmospherical  vicissitudes  ;  heat  and  moist- 
ure, and  sometimes  cold  and  moisture,  combined  ; 
excessive  and  long  protracted  rains ;  uncleanness  ; 
assemblages  of  men ;  the  abode  of  the  sick  in  nar- 
row, confined  apartments  which  are  with  difficulty 
ventilated  and  encumbered  with  human  and  brute 
beings.  Now,  is  it  not  evident  that  in  these  data, 
well  attested,  we  must  seek  for  the  first  rule  which 
is  to  guide  us  in  the  adoption  of  sanatory  measures  ? 

On  the  other  hand,  it  seems  that  the  Cholera,  es- 
pecially since  it  has  been  transplanted  into  Europe, 
has  in  certain  cases  been  communicated  by  the  aid 
of  hot-beds  of  emanation,  in  which  the  disease  was 
as  it  were  concentrated ;  for  example,  in  conse  - 
quence  of  extensive  accumulations  of  men,  and  the 
crowding  of  patients  together  into  unwholesome, 
ill-ventilated  and  filthy  localities. 

The  Cholera,  also,  after  the  manner  of  all  exten- 
sive epidemics,  is  most  frequently  extended  and  mul- 
tiplied, by  the  influence  of  general  occult  causes, 
which  are  probably  diffused  through  the  atmosphere, 
the  deleterious  action  of  which  is  also  found  increas- 


190 

ed  and  favoured  by  the  concurrence  of  the  causes 
which  have  been  enumerated  above. 

These  constitute  the  most  positive  information 
afforded  by  physical  and  medical  observations,  re- 
garding the  causes  of  the  extension  of  the  disease  : 
it  is  within  these  limits  that  the  foundation  of  the 
measures  required  must  be  laid.  Concerning  sana- 
tory measures,  it  is  evidently  from  the  mode  of 
transmission  and  propagation  of  the  disease  that  we 
must  establish  t  he  nature  of  the  precautions  to  be 
taken. 

Quarantines  become  particularly  useful  against 
diseases  which  have  a  stated  period  of  incubation 
and  an  equally  fixed  period  of  transmissibility,  as  is 
the  case  with  small  pox,  for  example ;  but  with 
regard  to  the  Cholera,  there  is  nothing  which  proves 
that  the  disease  has  a  fixed  period  of  incubation,  a 
determinate  space  of  time  during  which  the  disease 
retains  the  property  of  transmission,  and  beyond 
which  this  property  is  extinguished  and  destroyed. 
Neither  have  facts  attributed  to  it  a  limited  sphere 
of  action.  Can  we  then  reasonably  establish  pre- 
ventive measures  in  the  same  degrees  and  forms  as 
if  we  possessed  the  data  in  which  we  are  deficient  ? 

In  epidemics  similar  to  the  one  under  considera- 
tion, the  disease  itself  is  perhaps  not  the  most  formi- 
dable scourge.  The  moral  effect  exerted  upon  the 
inhabitants,  and  its  dreadful  consequences,  are  not 
less  to  be  apprehended.     If  we  restrict  commer- 


191 

cial  relations  too  rigorously  by  quarantines ;  if  we 
drive  back  populations  upon  themselves  by  means 
of  military  cordons  ;  if  we  agglomerate  the  sick  in 
lazarettos,  we  will  precipitate  the  dreadful  event, 
augment  the  misery,  multiply  the  elements  of  pro- 
duction and  the  causes  of  the  disease,  and  create 
new  hot-beds  of  choleric  emanations  ;  and  those 
measures  employed,  in  all  the  good  faith  of  non- 
savoir,  in  order  to  preserve  nations  from  the 
disease,  would  on  the  contrary  have  a  direct  ten- 
dency to  produce,  propagate,  and  aggravate  it. 

In  the  numerous  epidemics  of  Cholera  which  we 
have  had  occasion  to  meditate  upon,  both  in  Asia 
and  Europe,  patients  placed  in  salubrious  situations 
are  visted,  touched,  moved,  changed,  dressed,  and 
carefully  attended,  yet  do  not  communicate  the 
Cholera:  physicians  proceed  to  the  examination 
of  the  bodies  after  death,  dwelling  long  and  minutely 
in  their  investigations,  yet  they  have  not  contracted 
the  disease.  Numerous  experiments  have  been 
made  with  the  view  of  shedding  light  upon  the  man- 
ner in  which  the  disease  is  transmitted  :  one  has 
inoculated  himself,  has  even  injected  into  his  veins 
the  blood  of  individuals  actually  seized  and  even 
dying  with  the  Cholera ;  another  has  inoculated 
himself  with  the  mucous  matters  discharged  by 
vomiting  and  by  stool ;  another  has  rubbed  his  skin 
with  the  same  substances  ;  some  have  laid  down  in 
the  same  beds  with  cholerics  and  enveloped  them- 


192 

selves  in  the  clothes  which  these  patients  have  just 
quitted,  and  others  again  have  gone  close  to  them 
in  order  to  inhale  their  dying  breath ;  yet  always 
without  serious  consequences. 

Far  be  from  us,  however,  the  rash  thought  of  pro- 
scribing useful  precautions,  and  condemning  pru- 
dent measures.  On  the  contrary,  these  useful  pre- 
cautions, we  call  for  them,  we  plead  for  them  with 
all  our  energy  :  but  for  the  interest  of  commerce 
and  society,  we  desire  that  the  endeavour  should  be 
to  keep  these  precautions  and  measures  within  just 
limits  ;  we  particularly  desire  that  they  should  be 
applied  with  discretion.  Directed  by  profound 
knowledge,  and  especially  by  the  light  of  experience, 
they  will  profit  nations  without  being  a  burden  to 
them.  To  individual  calamities,  to  the  eventful 
misfortune  of  disease,  they  would  not  add  the  uni- 
versal calamities,  the  infallible  misfortune  of  poverty, 
a  scourge  more  formidable  still  than  the  Cholera. 

It  is  with  a  very  correct  perception  of  what  is 
right,  and  a  very  proper  concern  for  his  triple  re- 
sponsibility as  a  man,  citizen  and  magistrate,  that 
the  minister  invokes,  in  this  perilous  conjuncture,  the 
illumination  of  science  and  the  knowledge  which 
flows  from  observation.  Under  such  circumstances, 
it  is  not  merely  necessary  that  the  impression  made 
should  be  powerful,  but  it  is  particularly  necessary 
that  it  should  be  just. 


INSTRUCTIONS 


TO 


ADMINISTRATIVE  AUTHORITIES, 

IN    CASE    THE    DISEASE    IS    THREATENED. 


/ 


What  is  the  conduct  to  be  observed  by  the 
government  provided  the  disease  is  threatened? 
What  should  it  direct  in  case  of  its  invasion  ? 

One  measure  which  prudence  recommends  be- 
fore every  other,  is  to  cause  the  frontier  towns  to 
be  medically  and  carefully  inspected,  in  order 
to  make  known,  with  perfect  exactitude,  and  at 
every  instant  the  occurrences  there  taking  place, 
both  in  relation  to  the  sanative  state  in  general,  and 
the  Cholera-Morbus  in  particular.  The  journals, 
without  examination  or  remark,  spread  news,  which 
are  not  the  less  alarming  though  on  the  morrow 
proved  untrue ;  too  often  do  they  exaggerate  dis- 
turbances, in  order  to  add  interest  to  the  recital. 

With  the  view  of  obviating  such  serious  in- 
conveniences, enlightened  and  prudent  phy- 
sicians should  instantly  be  attached  to  the  embas- 
sies and  legations  of  the   neighbouring  countries 

18 


194 

already  suspected  or  even  attacked  ;  such  a 
measure,  adopted  immediately,  would  be  of  the 
greatest  utility.  Through  the  daily  correspon- 
dence of  these  physicians,  the  government  would 
receive  documents  in  which  might  be  placed  a 
degree  of  confidence  proportionate  to  the  dis- 
crimination observed  in  the  choice  of  the  phy- 
sicians. 

Such  a  choice,  therefore,  should  not  be  deputed 
to  individuals  who  are  strangers  to  the  medical 
profession.  With  a  constitutional  government  in 
which  the  responsibility  of  ministers  should  like- 
wise be  a  practical  reality,  with  the  elective  system 
by  which  we  are  governed,  learned  bodies  com- 
bining the  necessary  information  for  judging  cor- 
rectly, should  be  exclusively  consulted  under  such 
circumstances. 

Boards  of  Health  should  be  instituted  in  the 
departments,  especially  in  places  bordering  on  in- 
fected or  suspected  countries.  France,  in  this 
measure,  would  find  an  additional  source  of  ob- 
servation and  preservation. 

Let  the  government  prepare  in  advance,  places 
of  observation  and  the  depots  to  be  established 
in  case  of  actual  menace :  to  it  the  duty  of  per- 
forming belongs,  it  is  ours  to  advise.  When 
pressing   occasion  for   lazarettos  and   quarantines 


195 

shall    be    truly   felt,   it    should   not  be  taken   by 
surprise. 

It  is  quite  natural  to  suppose  that,  from  the 
force  of  circumstances,  these  different  precaution- 
ary measures  will  be  first  adopted  in  some  part 
of  our  frontiers.  It  is  absolutely  necessary  that 
sanatory  cordons  should  be  vigilant,  complete, 
and  faithfully  observed.  But,  on  this  subject, 
the  Academy  would  carry  its  provisions  still  far- 
ther :  an  intimate  conviction  and  unanimous  assent 
induce  us  to  declare,  that  it  is  only  upon  the 
frontiers  of  states  attacked  or  even  simply  sus- 
pected, that  the  preventive  measures  of  sanatory 
cordons  should  be  established ;  applied  to  the  in- 
terior, these  means  of  sequestration  would  be 
useless  and  dangerous.  It  is  proper  for  us  to 
sequester  foreign  nations,  who  might  bring  the 
Cholera  to  our  doors  ;  but  should  the  disease  be 
declared  among  us,  let  us,  like  true  brothers, 
instead  of  abandoning  one  another,  afford  mutual 
assistance. 

If,  in  spite  of  the  measures  taken  on  the 
frontiers,  the  disease  should  reach  us,  it  will  then 
have  arrived  by  the  epidemial  way  ;  and  then, 
the  hygieinic  are  the  only  admissible  means : 
every  means  of  sequestration  would  be  super- 
fluous. 

Sanatory  cordons  upon  the  frontiers  would  pos- 


196 

sess  real  utility,  and  be  of  pretty  easy  application, 
without  presenting  the  disastrous  inconveniences 
attendant  upon  them,  if  they  were  compacted  or 
circumscribed  towards  the  interior,  and  if,  for 
example,  they  sequestered  one  department  from 
other  departments,  one  city  from  another  city,  or 
even  one  quarter  from  another  quarter. 

Warsaw  and  its  environs  have  exhibited  striking 
examples  of  the  fatal  consequences  occasioned  by 
useless  sequestrations  from  city  to  city,  from  town 
to  town,  and  from  family  to  family. 

Persons  attacked  with  the  Cholera  should  be 
disseminated  over  large  spaces,  and  placed  in 
elevated,  dry,  and  freely  ventilated  habitations. 
Let  the  administration  take  its  precautions  before 
hand.  Each  threatened  city  should  have  one  or 
several  hospitals  for  Cholericks,  according  to  its 
population :  it  would  be  still  better  to  establish 
these  patients  in  barracks,  or  even  under  tents, 
if  the  season  should  permit.  These  establish- 
ments, whatever  they  may  be,  should  be  placed 
on  elevated  situations,  at  a  distance  from  large 
evaporations  from  rivers  or  lakes,  in  the  midst  of 
an  open  country,  upon  a  soil  entirely  exempt  from 
humidity,  and  otherwise  purified  by  every  possible 
means. 

And  as  examples  of  relapses  are  frequent, 
especially  when  the  patients  remain  in  the  midst 


197 

of  influences  capable  of  developing  the  disease, 
it  would  be  essential  to  have  houses  of  convales- 
cence, places  of  refuge,  for  the  benefit  of  in- 
dividuals too  recently  cured  to  return  to  the  bosom 
of  their  families,  or  re-enter  the  precincts  of  cities. 
It  is  requisite  that  a  certain  space  of  time  should 
elapse  between  the  moment  the  convalescent 
leaves  the  seat  of  diseased  emanation  and  the  period 
he  sets  out  to  mingle  with  the  rest  of  society. 

As  it  respects  general  precautions,  the  regimen 
of  hospitals,  the  interior  of  prisons,  extensive 
work-shops  and  manufactories,  colleges,  large 
boarding-houses,  and  masses  of  troops,  require 
much  more  rigid  inspection  than  is  customary. 
In  the  wards  of  hospitals,  let  the  beds  be  placed 
at  a  greater  distance  asunder,  and  cleanliness  be 
more  strictly  attended  to ;  let  scrubbing  of  tiled 
floors  be  interdicted,  the  humidity  resulting  there- 
from would  be  pernicious  ;  let  the  encumbrances  of 
the  different  houses  of  detention  be  diminished, 
and  their  purification  be  strictly  enforced ;  let 
the  crowded  state  of  work-shops  be  prohibited ; 
let  the  caserns  be  supervised ;  let  the  soldiers 
bathe  as  frequently  as  possible,  their  winter  panta- 
loons be  given  them  early,  their  body-linen  fre- 
quently changed,  a  little  wine  be  distributed  to 
them,  together  with  a  rather  more  abundant 
supply  of  meat  and  a  little    less   of  vegetables, 

18* 


198 

and  let  still  greater  attention  be  paid,  if  it  can  be 
done,  to  the  general  health  of  the  troops  which  may- 
then  constitute  the  different  cordons  of  observation. 
All  these  precautions  will  be  productive  of  the 
most  beneficial  results. 

Among  the  various  points  of  public  hygieine 
which  demand  special  attention,  under  the  suppo- 
sition that  the  Cholera  is  simply  threatened,  we 
would  specify  sinks,  common  sewers,  wells  and,  in 
the  country,  dung-pits.  The  sanatory  police  should 
take  such  precautions  that,  during  the  epidemic,  if 
it  should  reach  us,  no  operation  of  draining  or 
cleansing  common  sewers  or  sinks,  or  of  purifying 
wells,  should  be  undertaken  :  these  different,  works, 
incapable,  doubtless,  in  themselves,  of  producing 
the  disease  when  it  does  not  exist,  might  increase 
and  aggravate  it,  if  it  did  exist. 

Pools,  marshes,  rivers,  the  standing  water  in 
which  hemp  is  rotted,  and  water  used  for  domestic 
purposes,  should,  in  case  the  epidemic  makes  its 
appearance,  attract  additional  solicitude. 

There  would  be  rather  an  advantage  in  expend- 
ing a  little  less  in  the  construction  and  support  of 
lazarettos,  the  establishment  of  quarantines,  in  the 
sanatory  cordons,  in  the  appointment  of  directors, 
administrators,  and  sub-officers  of  the  public  health, 
and  on  the  other  hand,  disbursing  more  towards 


199 

promoting  both  private  and  public  salubrity. 

Moderate  labour  is  alwavs  consistent  with  the 
enjoyment  of  health.  For  this  reason,  that  species 
of  labour  which  would  tend  to  make  the  labouring 
classes  comfortable,  would  be  a  good  preservative 
against  the  Cholera.  It  would  be  still  more  so  if  the 
object  of  this  labour  is  to  add  to  the  general  salubrity. 
Hence,  the  Academy  suggests  to  the  local  authori- 
ties the  propriety  of  immediately  undertaking  the 
construction  of  works  of  general  utility,  and  espe- 
cially such  as  may  promote  public  salubrity  among 
unhealthy  communities. 

The  administration  should  also  ascertain  that  the 
tenements  of  the  poor  be  provided  with  a  sufficient 
number  of  apertures,  in  order  that  they  may  be 
properly  purified- 

Of  all  the  modes  of  transmission,  heretofore  men- 
tioned, of  which  the  Cholera  is  susceptible,  the 
epidemial  mode  is  the  most  common  and  evident. 
Consequently,  it  is  reasonable  to  direct  some  cf 
our  precautionary  measures  towards  this  point. 

The  communication  of  Cholera  through  the  me- 
dium of  persons,  or  patients,  affords  serious  and  just 
subject  fur  apprehension.  Against  them,  therefore, 
proper  sanatory  measures  should  likewise  be  em- 
ployed. 

The  extension  of  the  disease  by  means  of  mer- 
chandise, being  of  all  modes  the  most  contestable 


200 

and  the  least  averred,  it  is  not  just  to  coincide  with 
all  the  views  of  the  administration  upon  this  point. 
Besides,  excessive  measures  directed  against  com- 
merce, would  have  the  inevitable  inconvenience  of 
presenting  additional  allurements  to  smuggling,  and 
consequently  favour  and  increase  the  disease.  Now, 
smuggling,  which  is  naturally  composed  of  persons 
and  things,  that  is  to  say,  of  individuals  who 
carry  it  on,  and  of  merchandise  in  favour  of 
which  it  is  carried  on,  would  necessarily  become 
one  of  the  most  formidable  modes  of  extending  the 
Cholera. 

It  would  especially  be  necessary,  with  regard  to 
the  Cholera  in  particular,  to  draw  up  a  new  distribu- 
tive series  of  suspected  or  susceptible  merchandise, 
as  directed  by  the  ordinance  of  September.  1821. 
Every  communicable  disease  has  special  laws  of 
transmission  ;  each  must  therefore  have  a  different 
series  of  conductors,  bv  the  aid  of  which  it  is  more 
readily  extended.  Articles  declared  suspicious,  with 
respect  to  the  plague,  might  not  be  so  in  the  same 
degree,  and  probably  not  all,  where  the  Cholera 
is  concerned.  Let  us  add,  that  the  tables  annexed 
to  the  ordinance  of  1821,  considered  even  ab- 
stractedly of  the  Cholera,  present  incongruities 
and  anomalies,  which  the  physical  and  chemi- 
cal sciences  reprove,  and  which  it  is  indispensable 
to  abolish. 


201 


It  would  be  wise  to  provide  for  the  general  sub- 
sistence, in  case  of  the  proximity  of  the  disease.  It 
would  especially  be  prudent,  under  such  a  circum- 
stance, to  give  guaranty  and  security  to  the  numer- 
ous inhabitants  of  large  cities. 


INSTRUCTIONS 

j 

TO  THE  ADMINISTRATIVE  AUTHORITIES,  IN  CASE 
OF  INVASION  OF  THE  DISEASE. 


Having  given  such  instructions  to  the  authorities  as 
are  applicable  to  the  disease  when  merely  threaten- 
ed, let  us  now  proceed  to  mention  what  would  be 
requisite  if  the  Cholera  should  come  to  reign 
amongst  us. 

To  insure  a  just  distribution  of  medical  assistance 
among  individuals  in  destitute  circumstances ; 

To  see  that  patients  are  visited  and  succoured 
promptly :  here  success  entirely  depends  upon  the 
means  which  may  have  been  adopted  in  the  first 
moments  of  invasion  of  the  disease; 

To  prevent  several  patients  with  Cholera  from 
being  collected  in  the  same  chamber,  or  even  in  a 
narrow,  ill-ventilated  apartment,  and  encumbered 
besides  with  other  individuals  even  in  a  state  of 
health  ; 

To  supervise,  with  extreme  rigorousness,  the 
cleanliness  of  the  streets,  the  sweeping  and  washing 
of  markets,  the  cleansing  of  slaughter-houses,  the 


203 

purification  of  sewers :  to  afford  facilities  to  the 
indigent  of  bathing  occasionally,  twice  a  month,  for' 
instance,  and  also  the  means  of  changing  conve- 
niently their  body-linen.  It  is  necessary,  however, 
to  recommend  them  to  use  precautions,  both  with 
respect  to  baths  and  frequent  changes  of  linen,  so 
that  neither  the  one  or  the  other  of  these  means 
shall  leave  on  the  body  prolonged  humidity ; 

To  forbid,  in  general,  all  numerous  assemblages 
of  people,  whatever  may  be  the  motive.  Expe- 
rience has  proved  that  the  collection  of  considerable 
multitudes  has  resulted  in  increasing  and  aggra- 
vating the  malady  ; 

To  change  provisionally  the  organization  and  dis- 
tribution of  markets  ;  it  would  be  well,  especially, 
to  divide  and  multiply  them  considerably,  to  locate 
them  quite  near  the  barriers,  and  in  very  open 
situations  ; 

To  evacuate  all  caserns  situated  in  the  interior 
of  cities,  and  to  encamp  the  troops  in  salubrious 
positions  and  at  suitable  distances  ; 

To  purify  the  chambers  in  which  sick  persons 
have  resided,  either  by  the  aid  of  lotions  of  chlorure 
or  by  means  of  Guytonian  fumigations  ; 

To  regulate,  especially,  the  inhumations  by  the 
advice  of  the  members  of  the  profession.  It  will 
be  necessary  to  maintain  an  even  balance  between 
inhumations  too  precipitate   and  inhumations   too 


204 

long  retarded :  the  former  would  be  dangerous  to 
individuals,  in  a  disease  in  which  death  arrives  so 
suddenly  and  often  in  the  midst  of  syncopes  which 
may  for  a  greater  or  less  length  of  time  simulate 
death;  the  latter  might  be  dangerous  to  communities 
during  the  prevalence  of  an  epidemic,  in  which  ex- 
perience teaches  that,  uuder  certain  circumstances, 
every  patient  may  become  a  hot-bed  of  choleric 
emanations.  The  rules  to  be  laid  down  in  like 
cases  must  vary  according  to  the  intensity  of  the 
epidemic  and  also  according  to  the  epoch  at  which 
the  epidemic  has  arrived.  The  conduct  may  be 
different,  at  the  invasion  of  the  epidemic,  during  its 
greatest  intensity,  and  in  its  decline ;  it  may  vary 
also  in  those  moments  of  enervation,  which  is  some- 
times observed  in  the  geographical  march  of  the 
epidemic,  independently  of  the  variations  connected 
with  the  epochs  we  have  just  enumerated.  In  all 
cases  it  would  be  a  wise  precaution  to  sprinkle  lime 
upon  the  bodies  of  the  dead  when  prepared  for 
sepulture. 


INSTRUCTIONS  TO  PHYSICIANS, 


IN    CASE    THE    DISEASE    IS    THREATENED. 


Epidemics,  in  the  medical  history  of  nations, 
sire  events  of  grave  importance.  It  is  important 
that  their  history  should  be  recorded,  that  their 
remembrance  should  be  perpetuated,  in  order 
that  the  direful  lessons  of  these  calamities  be 
not  lost  to  succeeding  generations.  Let  us  add, 
that,  in  the  midst  of  these  disasters,  the  progress 
of  the  science  is  powerfully  facilitated,  and  phy- 
sicians find  brilliant  opportunities  of  confirming 
the  importance  of  their  services. 

The  epidemic  Cholera  has  presented,  in  the 
regions  which  it  has  traversed,  notable  variations 
in  relation  to  its  duration,  severity,  and  the  con- 
sequences which  have  resulted  from  it.  If  we 
are  doomed  to  experience  its  ravages,  it  is  neces- 
sary that  physicians,  in  the  various  points  in  which 
it  may  manifest  itself,  turn  to  the  best  account 
the  fatal  advantage  which  they  have  had  of 
studying  it :  in  order  that  the  experience  of  those 
nations  who  have  already  observed  it  may  prove 

19 


206 

profitable,  we  have,  on  our  part,  exhibited  this 
terrible  scourge  under  all  the  modifications  of 
which  it  is  susceptible. 

The  duties  of  physicians  will  vary  according 
as  populations  are  merely  threatened,  or  actually 
invaded,  by  the  Cholera. 

In  times  of  anxiety,  when  citizens  are  con- 
stantly in  dread  of  the  epidemial  invasion,  the 
physician,  always  calm,  should  apply  himself  to 
the  deep  study  of  this  disease,  in  order  that,  if  the 
dangers  be  realized,  he  may  not  enter  altogether 
as  a  novice  upon  the  career  which  the  Cholera, 
reigning  with  more  or  less  fury,  will  open  to 
him.  Epidemial  times  are  days  of  dread  and 
disorder ;  every  thing  is  then  done  with  precipita- 
tion ;  tumult  and  consternation  prevail :  it  is  in 
moments  of  perfect  tranquillity  then  that  we  must 
prepare  for  all  these  scenes  of  agitation  and  dis- 
tress. In  every  thing,  it  is  advantageous  that  the 
observer  possess  some  anticipated  notions  of  the 
objects  which  may  be  presented  to  his  view.  We 
study  with  greater  advantage  the  phenomena  of 
which  we  have  been  forewarned :  those  which 
come  upon  us  unawares,  confound,  and  often 
escape  us. 

Among  the  works  upon  the  Epidemic  Cholera, 
which  the  Academy  would  advise  as  most  useful 
for  perusal  and  study,  it  would  cite  the  treatise  of 


207 

Annesley,  that  of  Jameson,  of  Turnbull,  Christie, 
the  treatise  of  Lichtenstaet,  the  particular  ob- 
servations and  four  decades  of  cases,  of  M.M. 
Jachnichen  and  Marcus  ;  and  as  these  different 
treatises,  published  in  the  German  and  English 
languages,  have  not  been  translated  into  our  own 
tongue,  the  Academy  does  not  hesitate  to  recom- 
mend the  reading  of  the  report  which  it  has 
published  on  this  subject,  by  invitation  of  the 
government.  Notwithstanding  the  works  of  M. 
Deville,  of  M.  Keraudren,  M.  Larrey,  and  some 
others  upon  the  Cholera,  the  French  physicians 
have  not  yet  published  any  thing  complete  on 
this  subject. 

We  are  aware  that,  up  to  the  present  time, 
there  are  scarcely  any  among  the  French  phy- 
sicians who  have  had  an  opportunity  of  observing 
the  disease. 

The  physician  who  may  have  some  well-founded 
apprehensions  of  the  proximity  of  the  Cholera 
among  the  people  whose  health  is  confided  to  his 
care,  should  immediately  apply  himself  to  the 
minutest  investigation  of  the  topographical  con- 
ditions which  surround  him ;  he  should  seek  to 
ascertain,  in  all  their  statistical  details,  the  elements 
of  the  population  in  the  midst  of  which  he  is  em- 
ployed. Still  later,  by  the  aid  of  these  prelim- 
inary data,  he  will  be  enabled  to  fix  with  precision 
the  number  of  patients   compared  with  the  total 


208 

population,  and  the  number  of  deaths  relatively 
to  the  number  of  sick  ;  to  determine  the  classes,. 
professions,  sex,  ages,  and  constitutions,  which 
have  been  spared  or  attacked,  cured  or  fallen 
victims. 

By  means  of  preliminary  statistical  observations, 
he  will  avoid  confounding  with  individuals  ac- 
tually attacked  with  the  Cholera  the  number  of 
diseases  of  a  different  nature  which,  during  like 
seasons  of  the  year,  usually  manifest  themselves 
in  the  country.  He  will  distinguish  also,  in  the 
lists  of  mortality,  the  deaths  happening  in  con- 
sequence of  Cholera,  from  those  which,  at  the 
same  epochs  of  the  year,  and  in  ordinary  times, 
occur  among  the  inhabitants  of  the  country  in 
consequence  of  diseases  of  a  different  nature. 

The  physician  should  try  to  extend  very  far 
this  species  of  study  of  medical  topography  and 
statistics.  In  the  number  of  useful  consequences 
which  would  result  from  this  order  of  investi- 
gation, he  will  be  eager  to  state  to  the  adminis- 
trative authorities  the  ameliorations,  which,  in 
this  particular  circumstance,  the  public  and  pri- 
vate hygieine  demand.  He  will  ascertain  the 
sanatory  state  of  all  numerous  assemblages  ;  he 
will  direct  the  local  administrations  where  they 
should  place  those  choleriques  who  will  not,  or 
cannot,  be  treated  in  dwelling-houses;    he   will 


209 

also  endeavour  to  have  a  house  of  convalescence 
prepared  before-hand ;  he  will  especially  inspect 
the  daily  occurrences  in  hospitals ;  he  will  visit 
with  more  than  ordinary  attention,  jails,  prisons, 
the  caserns,  colleges,  and  extensive  work-houses. 
It  would  be  a  matter  of  high  importance  to 
study  the  sanatory  state  of  various  species  of 
animals,  previous  to  the  epidemic,  during  its  con- 
tinuance, and  after  its  cessation.  It  would  be 
well  to  note  the  differences  presented  by  the 
animals  appertaining  to  the  country  and  those 
which  are  merely  temporary ;  but  he  should 
study  more  particularly  the  diseases  of  domestic 
animals,  of  those  especially  which  share  with 
man  the  labours  of  agriculture,  and  which  con- 
stitute a  great  portion  of  the  riches  of  rural 
economy. 


19* 


INSTRUCTIONS  TO  PHYSICIANS, 

IN  CASE  OF  INVASION. 


It  is  especially  under  circumstances  of  invasion 
of  the  disease,  that  the  obligations  of  the  physician 
assume  a  highly  important  character.  It  is  incum- 
bent upon  members  of  the  profession,  to  employ  that 
influence  which  knowledge  gives  them,  and  that 
consideration  which  appertains  to  their  station,  in 
controlling  the  moral  of  the  families  whose  confi- 
dence they  have  acquired.  They  should  be  in- 
structed as  to  the  real  dangers  of  the  disease,  the 
nature  of  the  precautions  to  be  observed  with  the 
view  of  avoiding  it,  and  the  means  which  it  is  neces- 
sary to  employ  in  order  to  obtain  its  cure.  Here, 
every  physician  may  more  easily  adopt  the  modifi- 
cations required  by  the  different  constitutions  upon 
which  he  may  be  called  on  to  act. 

In  general,  when  called  on  to  study  an  epidemic, 
we  will  not  be  excusable  if  we  neglect  the  collection 
of  a  certain  number  of  cases.  These  cases  should 
be  numerous,  varied,  complete :  they  should  present 
isolated  facts  of  the  disease,  considered  in  the  total 


211 

duration  of  the  epidemic,  from  its  commencement, 
during  its  greatest  intensity  and  at  its  close  :  they 
should  also  embrace  the  different  modes  of  termina- 
tion which  the  epidemic  experiences.  With  the 
cure,  they  should  make  known  the  methods  of  treat- 
ment which  have  been  most  successful  at  each  epoch 
of  the  disease,  considered  in  general :  with  the  fatal 
termination  they  should  give  the  general  results  of 
the  cadaveric  lesions,  observed  also  at  different 
epochs  of  the  epidemic,  that  is  to  say,  at  its  invasion, 
towards  its  middle,  and  during  its  decline. 

When  the  disease  has  manifested  itself,  the  phy- 
sician should  endeavour  to  fix  the  epoch  of  its 
appearance,  and  determine  the  precise  moment  of 
its  developement :  he  should  ascend  to  the  first 
individual  actually  attacked,  and  satisfy  himself  as 
to  the  circumstances  under  the  influence  of  which 
this  individual  was  seized.  In  the  same  manner  he 
should  observe  with  particular  care  the  first  patient 
attacked  by  the  epidemic,  inform  himself  whether 
the  disease  exists  throughout  the  neighbourhood,  or 
if  the  epidemical  fiend  has  appeared  in  certain 
places  only:  he  should  also  try  to  discover  the 
manifest  state  of  these  differences. 

In  the  same  manner  he  should  trace  the  progress 
of  the  disease  throughout  all  the  patients  who  may 
have  been  successively  attacked  by  it,  and  under 
the  diverse  circumstances  of  localities,  approxima- 


212 

tions,  relations,  and  communications  which  have 
conduced  to  the  extension  of  the  disease.  He  should 
draw  up  a  species  of  geographical  chart  of  the  epi- 
demic ;  trace  its  itinerary ;  arrange  its  genealogy, 
and  thereby  follow  it  step  by  step  from  the  first  to 
the  last,  and  from  its  feeblest  impressions  to  its  most 
disastrous  desolations. 

He  should  endeavour  to  institute  a  comparison 
between  the  medical  topography  of  the  places  where 
the  disease  took  its  rise,  the  topography  of  the 
countries  wherein  it  has  been  most  easily  estab- 
lished, and  the  topography  of  the  neighbouring  ter- 
ritories which  the  Cholera  has  not  pervaded. 

He  should  try  to  find  out  the  conditions  and 
causes  of  these  differences,  under  the  three  follow- 
ing points  of  view  : 

1.  The  countries  which  have  been  violently  and 
repeatedly  attacked  ; 

2.  The  places  which  have  been  but  partially  and 
transiently  visited ; 

3.  The  territories  which  have  been  completely 
preserved,  either  fortuitously  or  by  the  intervention 
of  certain  sanatory  measures. 

The  main  points  which  he  should  endeavour  to 
elucidate,  are  embraced  by  the  following  questions : 

How  does  it  happen  when  one  is  placed  far  from 
the  centre  of  the  disease,  without  the  sphere  of  its 
action  ? 


213 

Can  an  individual  attacked  with  the  Cholera,  and 
transported  to  a  distance,  transmit  the  disease  to 
other  persons  in  the  midst  of  conditions  otherwise 
generally  salubrious  ? 

In  case  of  the  affirmative,  what  are  the  circum- 
stances which  favour  this  transmission  ?  What,  on 
the  contrary,  are  those  which  retard  or  prevent  it? 

Can  an  individual  in  good  health,  from  the  sole 
circumstance  of  having  lived  in  the  midst  of  dis- 
eased populations,  carry  the  disease  with  him  in 
travelling  ?  What  are  the  known  conditions  which 
augment  or  diminish  this  property  of  transportation? 

Can  persons  who  shall  merely  have  traversed 
countries  where  the  Cholera  reigns,  without  being 
attacked  by  it,  become  loaded  with  emanations 
from  the  disease,  and  thereby  transport  it  to  other 
places  ? 

An  individual  labouring  under  the  reigning  Chol- 
era, transferred  far  from  the  region  where  the  dis- 
ease originated,  does  he  acquire  greater  chances  of 
cure  than  if  he  had  remained  in  the  place  where 
attacked  ? 

A  family,  a  body  of  soldiers,  any  assembly  of 
persons  whatsoever,  among  which  the  Cholera 
reigns,  do  they  succeed  in  divesting  themselves  of 
the  disease  more  speedily  by  removing  from  the 
place  where  the  scourge  had  assailed  them  ? 


214 

Different  substances  in  the  immediate  use  of 
cholericks,  such  as  bed-clothes,  matresses,  body- 
linen,  tissues,  garments,  &c,  carried  to  a  distance 
from  the  hot-bed  of  the  disease,  do  they  preserve 
for  a  greater  or  less  length  of  time  the  capability  of 
transmitting  the  Cholera  to  persons  who  might 
make  use  of  them  or  who  should  only  have  occasion 
to  handle  them  ? 

Other  articles  worn,  touched,  preserved,  by 
patients,  such  as  moveables,  books,  papers,  jew- 
els, can  they  transport  the  disease  far  from  the  seat 
of  action  and  beyond  the  conditions  capable  of  giv- 
ing rise  to  a  new  epidemial  region  ? 

Can  animal,  vegetable,  or  mineral  substances, 
alimentary  or  other  substances  which  have  merely 
had  a  place  in  the  country  where  the  disease  reigns, 
and  have  not  been  touched  by  the  sick,  transmit 
the  Cholera  to  a  distance  ? 

Living  animals,  whether  domestic,  or  cattle, 
which  have  remained  in  the  country  where  the 
Cholera  prevails,  can  they,  by  change  of  place, 
carry  with  them  the  property  of  communicating  the 
disease  ? 

The  solution  of  these  questions,  we  may  briefly 
observe,  is  arduous,  and  the  attempts  to  solve  them 
would  be  perilous.  Therefore  should  we  be  con- 
tent with  collecting  and  turning  to  advantage  the 
fortuitous  circumstances  which,  arising  during  the 


215 

course  of  the  disease,  either  from  generous  devoted- 
ness  or  adventurous  calculations,  might  furnish,  in 
this  respect,  some  invaluable  documents. 

There  is  another  series  of  questions,  which  might 
be  more  easily  answered,  and  the  essays  for  their 
solution  would  be  void  of  danger. 

We  should  endeavour  to  ascertain  whether,  in 
consequence  of  large  assemblages  held  in  opposition 
to  the  laws,  the  extension  of  the  disease  has  been 
favoured  ;  we  should  examine  how,  in  such  cases, 
the  disease  has  affected  the  inhabitants  of  different 
communities,  after  a  fair,  a  market-day,  or  a  public 
festival. 

At  what  epoch  has  the  Cholera  appeared  in  the 
country,  and  how  long  has  it  reigned  there  ? 

After  having  entirely  quitted  a  country,  has  it 
sometimes  re-appeared,  and  under  what  peculiar 
circumstances  has  it  thus  appeared  the  second 
time  ? 

What  was  the  general  state  of  the  atmosphere 
some  time  previous  to  the  appearance  of  the  dis- 
ease, then  during  its  reign,  and  also  at  the  epoch  of 
its  cessation  ?  A  summary  of  the  barometrical, 
thermometrical  and  hydrometrical  observations  du- 
ring these  intervals  should  be  given.  Electromet- 
rical  observations  if  they  could  be  conjoined, 
would  also  have  their  importance. 


216 

What  direction  of  the  horizon  does  the  Cholera 
seem  disposed  to  pursue,  in  traversing  a  country  ? 

During  the  prevalence  of  the  Cholera,  has  it  been 
noticed  that  there  are  any  conditions  of  persons 
more  subject  to  its  attacks  than  others  1  if  so,  what 
were  the  circumstances  of  locality,  profession,  regi- 
men, habit,  age,  sex,  and  fortune  which  seconded 
or  opposed  the  invasion  of  the  disease  ? 

Is  there  one  period  of  the  disease  in  particular  ? 
is  there  one  epoch  of  the  epidemic  in  general  in 
wThich  the  extension  is  most  facile  and  most  prompt? 
This  facultv  of  extension,  does  it  seem  to  be  estab- 
lished  in  a  direct  ratio  to  the  violence  of  the  general 
disease  ? 

Have  we  any  reason  for  deciding  whether  the 
disease  has  always  extended  in  the  epidemic  way 
or  whether  it  has  been  propagated  by  emanations 
around  the  sick,  by  migrations  of  persons,  or  by 
transportation  of  merchandize  ? 

Have  we  remarked  that  the  Cholera  exercised 
any  influence  upon  intercurrent  diseases  spread 
over  the  country,  and  what  was  this  influence  ? 

What  are  the  data  relative  to  the  number  of 
deaths  in  a  stated  population,  and  to  the  proportion 
of  cures  and  deaths  among  a  certain  number  of 
individuals  attacked  ? 

What  method  of  treatment  has  most  generally 
proved  successful  ? 


217 

What  modifications  is  it  necessary  to  make  in 
the  treatment  at  the  different  epochs  of  the  epidemic, 
at  its  invasion,  its  most  intense  period,  and  decline ; 
and  also  in  those  periods  when  we  know  that  the 
epidemic  Cholera,  independently  of  the  periods 
of  time  we  have  just  indicated,  presents  movements, 
either  of  exacerbation  or  declension,  which  discon- 
cert the  most  attentive  observers  ? 

Between  patients  who  have  received  the  assist- 
ance of  art,  and  those  who  have  been  left  to  the 
efforts  of  nature  alone,  what  has  been  the  differ- 
ence in  the  proportional  number  of  deaths  and 
cures,  and  also  the  difference  in  the  celerity  and 
stability  of  the  cure  ? 

Have  we  been  able  to  form  a  decisive  opinion 
upon  the  general  effects  of  opium,  calomel,  sulphate 
of  quinine,  sub-nitrate  of  Bismuth,  musk,  oil  of 
cajeput,  ammonia,  and  of  certain  other  medicinal 
substances? 

Has  blood-letting  in  general  been  productive  of 
good  effects  1  and,  in  the  number  of  individuals 
submitted  to  venesection,  are  there  many  in  whom 
the  blood  would  not  flow?  Under  the  influence 
of  what  circumstances  has  this  phenomenon  been 
noticed  ? 

Have  we  heard  that  physicians  or  the  public 
have  had  successful  recourse  to  any  new  remedy? 

20 


218 

What  have  been  the  most  ordinary  consequences 
of  the  disease,  as  to  its  consecutive  effects  upon 
different  constitutions  in  severe  cases,  when  the 
disease  has  not  terminated  by  death  ? 

Have  there  been  any  examples  of  relapse  or  sec- 
ond attack  after  a  well  established  cure? 

Can  we  determine  whether  the  disease,  by  its 
general  influence,  appears  to  leave  in  the  constitu- 
tions of  individuals  any  important  modification? 

What  are  the  general  results  of  autopsic  ex- 
aminations made  at  different  epochs  of  the  disease, 
in  particular  and  in  general,  and  also  at  the  different 
periods  of  intensity  of  the  epidemic  ? 

As  soon  as  an  example  of  epidemic  cholera  pre- 
sents itself  to  medical  observation,  the  physician 
should  inform  the  competent  authority  and  at  the 
same  time  request  the  opinion  of  some  one  of  his 
brethren.  This  measure,  both  for  the  interest  of  the 
science  and  humanity,  should  be  taken  without  bus- 
tle or  eclat ;  but  should  the  physician,  impelled  by 
an  excess  of  zeal,  be  in  too  great  haste  to  declare 
the  existence  of  epidemic  cholera,  let  him  be  on 
strict  guard  against  any  mistake.  Violent  colics 
and  diarrhoeas,  gastro-intestinal  irritations  which 
frequently  prevail  during  the  autumnal  season,  and 
which,  though  they  may  be  somewhat  analogous  to 
cholera,  are  not  cholera,  might  easily  lead  to  error. 
We  know  too  well  that  epigastral  anxieties,  vomit- 


219 

ings,  diarrhoeas,  and  even  contractions  of  the  limbs 
are  connected,  though  in  slight  degrees,  with  the 
diseases  just  enumerated. 

Neither  should  we  confound  epidemic  cholera 
with  sporadic  or  indigenous  cholera,  if  we  may  use 
the  expression.  The  latter,  which  is  observed  al- 
most every  where  and  at  the  same  time  with  the 
diseases  of  summer  and  autumn,  is  less  acute,  less 
violent  and  fatal :  it  never  passes  beyond  a  certain 
extent  of  country,  and  attacks  but  a  very  small  num- 
ber of  persons  at  the  same  time. 

The  description  of  the  symptomatology  of  the 
cholera  may  be  recapitulated  as  follows  :  physicians 
will  ea-ily  recognize  it  by  these  characters  : 

Epigastral  pains  and  anxieties ;  repeated  vomit- 
ings ;  frequent  stools ;  the  matters  voided  consist- 
inw  at  first  of  recently  invested  substances,  soon  ap- 
pear  fluid,  whitish,  flocculent ;  violent  cramps  in  the 
superior  and  inferior  extremities ;  coldness  of  the 
body  and  abdomen  ;  suppression  of  urine;  the  skin 
of  the  extremities,  of  the  feet  especially,  pale,  humid 
and  wrinkled  ;  tongue  white,  moist  and  cold  ;  pecu- 
liar expression  of  the  countenance  ;  distortion  of  the 
features,  hippocratic  face  ;  respiration  scarcely  per- 
ceptible ;  sinking  and  disappearance  of  the  pulse. 

Now,  as  it  concerns  the  treatment,  we  may  say 
in  general,  that,  in  the  first  period  of  the  dis- 
ease, which  is  characterized  by  coldness  of  the  sur- 


220 

face  of  the  body  and  concentration  of  the  vital- 
ity internally,  we  would  advise  frictions,  either 
dry,  or  compound  ;  the  radiation  of  caloric  to  the 
surface,  by  every  appropriate  means  ;  warm  cover- 
ing ;  vapour  baths,  various  rubefacients,  cuppings, 
sinapisms  and  blisters. 

It  is  also  with  the  view  of  bringing  back  the  cir- 
culation to  the  circumference, in  very  young  persons 
of  a  robust  constitution,  that  bleeding  has  been  hap- 
pily employed  at  the  period  of  •imminence  and  as 
near  as  possible  to  the  moment  of  invasion  of  the 
disease. 

In  this  period,  may  also  be  administered  in- 
ternally and  with  advantage,  veiy  warm  aromatic 
infusions  ;  such  diffusible  stimulants  as  the  irritabil- 
ity of  the  stomach  will  permit ;  aromatic  oils  com- 
bined with  alcohol  and  in  conjunction  with  lauda- 
num, ether,  ammonia,  James'  powder,  Dover's  pow- 
der, &c. 

The  special  alteration  of  the  gastro-intestinal  mu- 
cous membranes  has  been  combated  by  calomel, 
rhubarb,  aloes,  magnesia,  either  separately  or  in 
combination,  giving  them  according  to  the  indica- 
tions furnished  by  the  individual  constitution. 

At  the  nervous  period,  with  typhoid  tendency, 
and  even  with  mutations  or  transformations  of  the 
cholera  into  typhus — cinchona,  musk,  valerian,  bis- 


221 

ninth,  camphor,  and  oil  of  cajeput  have  been  given, 
together  with  such  other  means  as  are  generally 
adopted  in  the  treatment  of  typhus. 

With  the  view  of  attacking  the  prominent  symp- 
toms of  the  disease  separately,  there  have  been 
given, 

For  the  purpose  of  arresting  the  vomitings,  Riv- 
erious'  draught,  opium,  cold  drinks,  and  ice  ; 

Against  the  frequency  of  the  stools,  injections 
containing  laudanum  into  the  rectum,  aromatic  fric- 
tions upon  the  abdomen,  and  sinapisms  ; 

Against  the  pains  and  contractions  of  the  mus- 
cles, frictions  with  the  oil  of  turpentine,  or  oil  of 
cajeput ;  and  these  means  have  appeared  so  much 
the  more  efficacious,  when  they  concurrently  tend- 
ed to  warm  and  stimulate  the  chilled  surfaces  of  the 
skin,  and  rouse  the  diminished  energy  of  the 
nervous  function,  so  remarkable  in  this  disease. 

As  for  the  rest,  concerning  the  further  descrip- 
tion of  the  nature  and  treatment  of  cholera,  the 
Academy  begs  leave  to  decline  more  ample  details, 
referring  the  reader  to  what  has  already  been  men- 
tioned on  this  subject  in  the  first  part  of  the  report. 

The  Academy  would  again  insist  upon  the  neces- 
sity of  urging  the  employment  of  therapeutic  means 
from  the  commencement  of  the  disease.  In  this 
respect  physicians  should  have  an  understanding 

20* 


222 

with  one  another,  and  also  with  the  administration, 
in  order  that  they  may  be  multiplied  on  all  points, 
so  that  patients  may  readily  obtain  that  immediate 
assistance  of  which  they  stand  in  need. 

In  order  that  the  assistance  which  persons  in  em- 
barrassed or  indigent  circumstances  require  may 
be  particularly  expedited,  it  would  be  adviseable  to 
to  augment  the  number  of  physicans  and  surgeons 
attached  to  benevolent  institutions. 

It  would  be  desirable  that  every  physician  should 
be  compelled  to  certify  the  precise  nature  of  the 
disease  which  has  occasioned  death,  whenever  this 
deplorable  event  takes  place.  This  would  be  the 
only  means  of  ascertaining  the  actual  number  of 
victims  in  the  course  of  the  epidemic. 

Under  circumstances  so  urgent,  and  where  the 
life  of  the  sick  depends  upon  the  promptitude  and 
opportunity  of  succour,  physicians  should  consider 
themselves  under  a  religious  obligation  to  carry  into 
the  exercise  of  their  art  much  more  eagerness  than 
is  usual  in  ordinary  times.  In  the  night  as  well  as 
the  day,  at  long  as  well  as  short  distances,  they 
should  always  be  ready.  The  business  on  hand  is 
not  to  snatch  here  and  there  a  single  victim  from 
death;  no,  entire  populations  must  be  plucked  at 
once  from  the  very  jaws  of  destruction.  Physicians 
impressed  with  the  vast  importance  of  the  mission 


223 

which  is  confided  to  them,  should  rouse  up  all  their 
energies ;  they  should  possess  that  courage  which 
the  precariousness  of  their  station  demands  ;  and 
the  courage  of  the  physician  consists  in  braving  the 
dangers  of  disease  in  the  midst  of  epidemics,  even 
as  that  of  the  soldier  impels  him  to  brave  death  on 
the  battle-field. 


ADVICE   TO    CITIZENS, 

IN  CASE  THE  DISEASE  IS  THREATENED. 


The  duties  of  the  administration  and  the  functions 
of  physicians,  under  the  two-fold  circumstance  of 
menace  and  invasion  of  the  disease,  are,  as  we  have 
just  seen,  difficult  and  laborious. 

In  the  midst  of  these  conjunctures,  the  first  ob- 
ligation on  citizens,  is  to  endeavour  to  second,  with 
all  ardour,  the  administrative  authorities  and  phy- 
sicians in  the  important  task  which  is  imposed  upon 
them.  It  does  not  require  a  great  effort  of  reason 
to  prove  that,  in  similar  circumstances,  the  safety 
of  society  is  the  supreme  law,  and  that  in  order  to 
succeed  in  saving  entire  communities,  every  indi- 
vidual should  sacrifice  a  portion  of  his  time,  his  for- 
tune, and  even  liberty.  This  concurrence  of  all 
parties,  always  so  easily  excited  among  Frenchmen, 
should  not  be  wanting  in  these  calamitous  times, 
if  need  should  be. 

Experience  has  proved  it  more  than  once : — in  ep- 
idemics, disorder  and  tumult  add  to  all  the  dangers. 
The  disease  gains  upon  a  greater  number  of  indi- 
viduals ;   the  symptoms  acquire  greater  intensity ; 


225 

assistance  is  more  difficult  and  less  efficacious,  and 
the  mortality  acquires  a  dreadful  increase.  Let, 
then,  the  citizens  associate  with  the  public  authori- 
ties in  order  to  prevent  disasters  upon  disasters. 
At  all  periods,  public  order  and  general  tranquillity, 
are  essential  to  the  enjoyment  of  prosperity  and 
happiness :  in  times  when  epidemics  reign,  order 
and  tranquillity  are  the  only  efficacious  means  of 
preservation  and  safety. 

So  long  as  we  are  merely  threatened  with  the 
invasion  of  the  disease,  it  is  scarcely  necessary  in 
France,  where  a  good  bygieine  generally  exists,  to 
deviate  from  the  ordinary  mode  of  life.  Indeed, 
there  would  be  an  advantage  in  making  no  change 
in  the  general  habits,  at  least  with  respect  to  per- 
sons who  are  in  perfect  health,  and  accustomed  to 
live  in  a  temperate  and  regular  manner. 


ADVICE   TO    CITIZENS, 

IN  CASE  OF  INVASION. 


But  should  the  disease  burst  forth,  a  more  than 
ordinary  attention  to  cleanliness,  personal  as  well 
as  domestic,  would  naturally  be  a  prime  object  of 
importance. 

The  constant  use  of  dry  and  aromatic  frictions, 
of  baths  slightly  stimulating ;  of  sufficient  exercise, 
falling  short  of  great  fatigue,  and  every  other  means 
capable  of  supporting  the  proper  performance  of 
the  function  of  the  skin,  will  be  of  great  utility. 

It  will  especially  be  necessary  to  avoid  suppres- 
sion of  the  perspiration,  chilliness,  exposure  to  hu- 
midity, to  rain,  and  to  the  inclemencies  of  the 
atmosphere,  especially  those  which  the  night  brings 
on. 

Let  the  body,  especially  the  loins,  abdomen  and 
flanks,  be  constantly  covered  with  flannel,  worn 
immediately  next  the  skin  ;  let  the  feet,  by  every 
appropriate  means,  be  guarded  from  cold  and 
dampness  :  coldness  and  humidity  of  the  feet  are 
among  the  most  frequent  causes  of  derangement  of 
the  intestinal  functions. 


227 

We  should  equally  endeavour  to  maintain  the 
digestive  functions  in  a  favourable  disposition  ;  it 
would  be  well  to  find  in  the  nature  of  the  aliments, 
and  perhaps  also  in  the  selection  of  certain  acces- 
sory medicinal  substances,  slight  tonics  and  diffus- 
ible stimulants,  in  strength  proportionate  to  the  ne- 
cessities of  different  individual  constitutions.  An 
aliment,  almost  exclusively  animal,  would,  by  the 
title  of  preservative,  have  a  salutary  effect.  Beef, 
mutton,  game,  eggs,  wheat  bread,  fresh  vegetables, 
in  small  quantities,  and  water  coloured  with  a  little 
wine,  these  are  the  general  bases  of  every  salubri- 
ous aliment.  It  would  be  proper  to  avoid  meats 
not  sufficiently  cooked,  smoked  meats,  salt  provis- 
ions, salt  fish,  pastry,  aqueous  and  crude  vegetables, 
and  unripe  fruits. 

Of  all  drinks,  very  weak  wine  and  water  is  the 
most  suitable ;  or  what  is  still  better,  wine  diluted 
with  four  times  its  quantity  of  the  mineral  waters 
of  Bussang,  Saint-Pardoux,  Saint-Gondon,  and 
Seltz.  Weak  cold  infusions  of  quassia,  hops,  balm, 
odoriferous  vervain,  &c,  might  be  substituted  for 
the  mineral  waters. 

Upon  ull  occasions,  spirituous  drinks  and  every 
excess  of  the  table  should  be  avoided  ;  an  indiges- 
tion, even  slight,  during  the  reign  of  the  Cholera, 
is  almost  sure  to  produce  the  disease. 

The  abuse  of  wine,  brandy,  and  spirituous 
liquors,  almost  inevitably  causes  the  Cholera :  we 


228 

cannot  too  often  repeat  this  to  persons  who  are 
in  the  occasional  habit  of  committing  such  excesses. 

It  has  been  observed  in  the  countries  where 
this  disease  has  prevailed,  that  all  individuals 
placed  within  the  sphere  of  its  action,  have  had 
the  constitution  modified  in  such  a  manner  that  a 
more  or  less  remarkable  diminution  of  the  cuta- 
neous and  digestive  functions  was  always  present. 
It  would  consequently  be  essential,  in  case  the  dis- 
ease is  threatened,  to  anticipate  this  general  im- 
pression and  prevent  its  developement. 

Every  person  living  within  the  sphere  of  activity 
of  the  epidemic  region,  who  escapes  the  Cholera, 
experiences,  nevertheless,  though  in  various  de- 
grees, the  disagreeable  influence  of  this  epidemic. 
This  influence  is  betrayed,  in  communities  in- 
vaded, by  a  general  uneasiness,  frequent  vertigo, 
exhaustion  carried  even  to  syncope,  pains  in  the 
stomach,  constipation,  borborygmi,  anorexia,  loss 
of  appetite,  and  a  gentle  diarrhoea  ;  in  a  word, 
by  an  universal  disturbance  of  the  intestinal 
functions.  This  influence,  extended  to  a  higher 
degree,  is  also  made  manifest  by  those  sponta- 
neous lassitudes,  and  that  annihilation  of  the  mus- 
cular powers,  which  so  frequently  indicate  the 
imminence  of  grave  diseases,  of  those  especially 
which  appertain  to  nervous  fevers  rather  than  to 
inflammatory  diseases. 


229 

Under  such  a  modification  of  .the  public  health, 
individuals  seized  with  indisposition,  even  slight, 
should  hasten  to  obtain  the  advice  of  a  member 
of  .the  profession.  In  medicine,  as  in  morals,  it  is 
more  easy  to  prevent  the  evil  than  to  cure  it ;  and 
for  this  reason,  the  resources  of  medicine  are  par- 
ticularly efficacious  against  that  state  which  is  no 
longer  health,  and  which  is  not  yet  disease. 

As  soon  as  the  first  symptoms  of  the  disease 
are  felt,  and  whilst  waiting  the  arrival  of  the 
physician,  an  effort  should  be  made  to  re-animate 
the  enfeebled  vital  action,  and  excite  warmth  in  the 
cold  surfaces  of  the  body  by  every  means  at 
command.  Aromatic,  or  even  spirituous  baths, 
with  the  precaution  of  drying  and  warming  the 
body  well  after  the  bath ;  the  radiation  of  caloric 
over  different  parts  of  the  skin,  by  passing  a 
heated  iron,  for  example,  at  a  certain  distance 
from  its  surface ;  sinapisms  repeated  in  sufficient 
numbers,  and  many  other  analogous  means,  will 
fulfil  this  first  object. 

Internally,  a  warm  aromatic  infusion,  a  few 
drops  of  ether  on  sugar ;  a  mixture  of  two  drops 
of  the  essence  of  mint,  and  one  drop  of  the 
tincture    of    Rousseau*   in   a   spoonful   of   sugar 


*  A  preparation  in  which  one  grain  of  opium  ia  contained  in 
six  drops  of  the  tincture. — Tr. 

21 


«* 


230 

and  water ;  four  or  five  drops  of  the  oil  of  cajeput, 
in  half  a  spoonful  of  mint  water,  and  a  spoonful 
of  the  syrup  of  ether.  A  draught  of  cool  lemon- 
ade, or  even  some  pieces  of  ice  in  the  mouth, 
might  allay  the  vomitings.  All  these  means  might 
be  employed  with  benefit  while  waiting  for  the 
preparation  and  administration  of  the  special  pre- 
scriptions of  the  medical  adviser. 

Frictions  with  alcohol  and  the  essence  of  tur- 
pentine, with  the  oil  of  cajeput  and  spirits  of 
camphor,  would,  for  the  time,  afford  relief  to  the 
pains  in  the  limbs. 

What   we   have   also    mentioned,    in    addition, 
respecting  the  treatment  of  this  disease,  will  serve 
as  a  further  guide  to  direct  persons  who  are  suf- 
ficiently intelligent  to  know  how  to  profit  by  them. 
Let  persons  who  do  not  inhabit  dwellings  suf- 
ficiently pure  for  such  a  state  of  disease,  or  who 
may  not  be  sure  of  obtaining  at  home  the  requisite 
assistance,  hasten  to  the  establishments  which  the 
administration  shall  have  prepared  for  the  purpose. 
Prom    calculations   made  in  Russia,  it  has   been 
ascertained  that,  by  comparing  individuals  in  em- 
barrassed circumstances  who  have  been  attended 
at  their  own  dwellings   with  those,  of  the  same 
class,  who  have  been  admitted   into  the  salubrious 
establishments  set  apart  for  them,  the  advantage 
has   been  immense   on    the    side    of   the   latter. 


231 

Among  them  the  disease  was  of  shorter  duration, 
the  pains  were  less  acute,  the  symptoms  less 
violent,  and  the  recoveries  more  numerous  and 
prompt.  For  the  cure  of  this  disease,  simple  or 
compound  baths,  and  aromatic  vapour  baths,  are 
often  required,  and  such  means  of  assistance  are 
not  easily  obtained  in  private  domiciles. 

The  epidemic  Cholera  does  not  attack  all  indi- 
viduals  without  exception  who  are  found  placed 
within  the  sphere  of  its  influence ;  it  is  necessary, 
in  order  that  the  attack  be  realized,  that  there  should 
be  a  particular  disposition  of  the  body,  a  deter- 
minate aptitude  for  contracting  it.  This  predispo- 
sition, this  aptitude,  is  eminently  incurred  by  fear, 
uncleanliness,  excesses  of  the  table  or  of  any  other 
kind,  the  abuse  of  wine,  brandy  and  cordials,  ex- 
posure to  cold  and  moisture  ;  and,  on  the  other  hand, 
it  is  by  avoiding  these  general  causes  of  insalubrity, 
that  the  Cholera  is  prevented.  This  special  pre- 
disposition, this  susceptibility,  exclusively  of  the  cir- 
cumstances which  we  have  just  enumerated,  is 
wanting  in  a  great  number  of  individuals.  It  is 
daily  diminished,  moreover,  in  proportion  as  the 
epidemic  extends  to  those  communities  who  pay 
great  attention  to  cleanliness,  are  more  enlightened, 
and  suffer  least  from  the  pressure  of  poverty. 

We  read,  every  day,  in  the  political  journals,  of 
newly  discovered  remedies  and  specifics  for  the  pre- 


232 

vention  and  cure  of  the  Cholera.  The  public  should 
always  be  on  their  guard  against  these  deceitful 
promises  of  preservation  and  cure :  the  least  incon- 
venience they  can  produce  is  to  give  false  security, 
and  distract  the  attention  from  the  use  of  those 
means  which  prove  decidedly  beneficial.  If  expe- 
rience should  make  known  remedies  more  general- 
ly efficacious  than  those  with  which  we  are  already 
acquainted,  if  it  should  discover  any  decided  pre- 
servative, the  Academy  will  not  delay  to  give  offi- 
cial notice  of  it  to  the  public. 

By  the  title  of  preservative,  we  would  advise,  in 
addition  to  what  we  have  already  mentioned  with 
regard  to  cleanliness,  the  frequent  washing  of  the 
hands  with  a  weak  solution  of  the  chlorate  of  lime, 
in  the  proportion  of  one  part  of  chlorure  to  one 
hundred  parts  of  water.  We  may  in  like  manner 
employ  all  the  disinfecting  chlorures  ;  frequent  or 
even  continued  fumigations  with  the  vapour  of  chlo- 
rine, by  means  of  the  different  apparatuses  to  be 
found  in  trade,  or  even  without  these  apparatuses,  by 
directly  disengaging  the  chlorine  from  the  chlorures 
by  means  of  vinegar. 

We  must  however  use  them  with  prudence  and 
intelligence  ;  we  might,  by  being  too  lavish  of  them, 
give  rise  to  injurious  super-excitement. 

After  the  epidemic  has  ceased,  be  very  cautious 
how  you  entirely  suspend   preventive  measures; 


233 

facts,  in  great  numbers,  attest  that  the  disease 
has  been  re-produced  in  the  same  place,  even 
with  greater  violence  and  intensity  than  at  the 
primary  invasion.  It  is  also  necessary  to  submit  to 
a  more  or  less  protracted  convalescence,  and  to  a 
regimen  more  or  less  severe,  the  countries  which 
have  just  been  released  from  the  Cholera.  The 
duration  of  all  the  other  conditions  of  this  conva- 
lescence of  places,  if  the  expression  may  be  used, 
should  be  regulated  by  the  members  of  the  profes- 
sion, who  will  themselves  take  advice  from  circum- 
stances actually  dependent  upon  the  epidemic. 

Extensive  cleansings  of  the  interior  and  apart- 
ments of  houses,  after  the  epidemic,  whitewashing 
the  walls,  and  washing  the  curtains  and  moveables, 
will  constitute  so  many  measures  which,  if  adopted, 
will  incontestable*  prove  beneficial. 

Often,  after  the  epidemic,  in  individuals  who 
have  been  attacked  by  it,  and  sometimes  also  in 
those  who  have  merely  experienced  the  epidemial 
influence,  of  which  we  have  previously  spoken,  we 
remark  a  want  of  tone,  a  considerable  alteration  in 
the  gastro-intestinal  functions ;  evident  derange- 
ments of  digestion,  diarrhoea,  dysentery  and  ob- 
stinate constipation ;  attesting  the  great  ravages 
which  the  epidemic  cholera  has  made  upon  the 
constitution  :  such  affections  of  the  health  demand 
great  attention. 


234 

It  is  by  means  of  the  fertile  instructions  of  ob- 
servation, derived  from  the  most  correct  sources, 
and  the  mighty  power  of  the  accumulated  expe- 
rience of  the  most  authentic  facts,  that  we  have 
obtained  the  different  periods  of  the  epidemic,  its 
simple  menace,  its  actual  invasion,  its  decline  and 
disappearance. 

The  Academy,  fully  convinced  of  the  vast  im- 
portance of  its  commission,  has  neglected  nothing 
that  could  elevate  it  to  the  utmost  height  of  its 
duties.  Each  member,  from  the  zeal  which  he 
has  shewn,  whilst  the  threatened  danger  is  yet  at  a 
distance,  has  fully  manifested  what  efforts  and  talents 
he  will  display5  should  he  be  called  on  to  attack  it. 

Sept.  \3th,  1831. 

(Signed) 

KERAUDREN,    President  ; 

CHOMEL, 

MARC, 

DESGENETTES, 

DUPUYTREN, 

LOUIS, 

EMERY, 

BOISSEAU, 

DESPORTES, 

PELLETIER, 

ITARD, 

DOUBLE,  Reporter. 

By  the  Academy, 

ADELON,  Annual  President ; 
B«n-  PORTAL,    Honorary  <$• 

Perpetual  President  ; 
PARISET,  Perpetual  Secretary. 

FINIS. 


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